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-- SERVICE ORDER <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 2100 NORTH ALAMEDA STREET ❑ COMPTON, CALIFORNIA 90222 ❑ (310) 886-3400 <br /> SAN DIEGO OFFICE NORTHERN CALIFORNIA <br /> 1-800-748-5744 EPA 01\D028277036 1-800-727-2879 <br /> 1-800-933-9194 <br /> DATE b j� \. jPNE TIME PICK UP DYES or,,6NO <br /> CUSTOMER y2%£l"�- ,/�r�:-;.ri' i` cQ (\ RESIDENT ❑ YES orp'NO <br /> BILLING ADDRESS ��� �'' .• r '� dyf4'�' xT'`T =,' OICJ��vCONTRACT CUSTOMER ❑ YES or ! ' NO <br /> PHONE, � _ ,° z' CONTACT ��. y CUSTOMER NUMBER 731 6,7 <br /> CUSTOMER EPA tl t � 1if-`✓ rJ s'b L# L) e` AMOUNT'. <br /> JOB SITE ADDRESS CHECK NUMBER �+ <br /> P.O.NUMBER 11() �°r ' <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: � <br /> COMMODITY f� <br /> HALIDES P.P.M. <br /> ❑ NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIL/MIXED OILS)STATE CODE <br /> *NO PLACARDS REQUIRED* <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE ' r <br /> *NO PLACARDS OR MARKINGS REQUIRED* NEXT SERVICE DATE %'--''`A <br /> ❑ OTHER DRUMS DRUM SIZE <br /> MANIFEST NO. '� s� �+ NO.OF GALLONS <br /> DRIVER ✓-55r' ``t� y s em`` TRUCK NO.&RT <br /> ❑ NON HAZARDOUS DRAINED USED OIL FILTER <br /> ❑ COMMERCIAL FILTER RECYCLING, 33210 Western Avenue, Union City,CA,510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ ALVISO INDEPENDENT OIL-5002 Archer Street•Alviso,CA 95502•CA1000161743•(408)262-1360 <br /> ❑ BAYSIDE OIL II,INC.•210 Encinal Street•Santa Cruz,CA 95060•CAD088838222•(408)427-3778 <br /> ❑ ARTESIAN OIL RECOVERY INC.*2306 Magnolia Street•Oakland,CA 94067•CAL000233905•(510) 839-4234 <br /> ❑ DeMENNO/KERDOON•2000 N.Alameda Street•Compton,CA 90222•CAT080013352• (310)537-7100 <br /> ❑ OCS-3255 N.Marks Street.•Fresno,CA 93722•CAD980673842•(559)485-5496 <br /> C RAMOS ENVIRONMENTAL* 1515 S.River Road*W.Sacramento,CA 95691 •CAD44003556•(916)371-5747 <br /> fJ` ASBURY ENVIRONMENTAL SERVICES•2549 Scott Avenue•Chico, CA 95928•CAL000827844 <br /> ❑ ALTERNATE FACILITY <br /> USED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to;rertify than the above named articles are properly classified, described, packaged, marked <br /> RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOST THE and Iabeledland Ore in proper condition for tran#orfation,according to the applicable regulations of <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Departmf:ra <br /> nt onspgr tion. <br /> *1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 Rpm.. X <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. j { CUSTOMER-SIGNATURE te/' DATE <br /> *1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR <br /> CONTAINS ANY P.C.B'S. PRINT NAME <br />