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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 CAD028277036 1-800-727-2879 <br /> 1-800-933-9194 <br /> ONETIME PICK UP DYES or�-NO <br /> DATE > •- <br /> CUSTOMER lJ`: �'`i>>r'% �l�/.r', ' �` 'z'� t'�d RESIDENT ❑ YES or-® NO <br /> BILLING ADDRESS r'" �./ i' CONTRACT CUSTOMER ❑ YES or/©--NO <br /> PHONE' <=�?)t. � CONTACT _ CUSTOMER NUMBER <br /> s f ? )-, «a ` '' ... <br /> CUSTOMER EPA# t~ ��y�� �k AMOUNT --, <br /> JOB SITE ADDRESS CHECK NUMBER <br /> P.O.NUMBER s <br /> CROSS STREETS CASH RECEIVED <br /> �/ .• r (AMOUNT) <br /> NOTES: PJ► �i eDa �"�.F�f��✓ <br /> �;. � +��+ �-� COMMODITY <br /> HALIDES P.P.M. <br /> -11f 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 . <br /> ❑ OTHER DRUMS DRUM SIZE <br /> MANIFEST NO. ��' i �f NO.OF GALLONS ✓fX.? <br /> f ' <br /> DRIVER 1a1� /�+x >�°s�., ' ' E 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 /> ❑ DeMENNOXERDOON•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 /> L4 RAMOS ENVIRONMENTAL• 1515 S.River Road•W.Sacramento,CA 95691 •CAD44003556• (916)371-5747 <br /> ❑ 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 certify that the above named articles are properly classified,described, packaged, marked <br /> RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled, and are in proper,condition for transportation, according to the applicable regulations of <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Department of TIansportati <br /> ANY <br /> *1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH / <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; X <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY RC.B'S_ CUSTOMER SIGNATURE 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 />