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rUnrvk Nk_).AL,)uUJ <br /> SERVICE ORDER <br /> No. N 632101 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE ❑ G`bMPTON, CALIFORNIA 90221 ❑ (310) 886-3400 <br /> SAN DIEGO OFFICE NORTHERN CALIFORNIA <br /> 1-800-748-5744 EPA CAD028277036 1-800-727-2879 <br /> DATE — i' [`,- `} ONETIME PICK UP OYES or ❑NO <br /> i <br /> } <br /> CUSTOMER !7 + 1 ,r - RESIDENCE ❑ YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> �� - w p �'^ <br /> PHONE__4,` 7 i � � Y CONTACT CUSTOMER NUMBER <br /> CUSTOMER EPA Il � � •� AMOUNT <br /> JOB SITE ADDRESS j 'i 1 S' S "'= CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY <br /> HALIDES 'f'G P.P.M. <br /> V NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIL/MIXED OILS)STATE CODE 221 <br /> *NO PLACARDS REQUIRED* <br /> ❑ NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE 133 <br /> *NO PLACARDS OR MARKINGS REQUIRED* NEXT SERVICE DATE <br /> ❑ OTHER DRUMS DRUM SIZE <br /> C- L%' .� (�- NO.OF GALLONS <br /> f,� <br /> MANIFEST NO. '" ��_-' <br /> DRIVER ! 1 f < 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•CAL000161743*(510)476;1740 <br /> ElBAYSIDE OIL II,INC.•210 Encinal Street•Santa Cruz,CA 95060•CAD088838222•(408)427=3778 L�si <br /> ❑ EVERGREEN ENV. .4139 N. Valentine Ave. * Fresno, CA 93722.CAD982446882*(510) 795-4400 <br /> 4-.,DEMENNO/KERDOON •2000 N.Alameda Street•Compton,CA 90222•CAT080013352•(310)537-7100 <br /> ❑ D/K DIXON*7300 Chevron Way*Dixon,CA 95620*CAT080012602*(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL.1515 S.River Road .W.Sacramento,CA 95691 .CAD044003556 .-(918)371-5747 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES•2549 Scott Avenue•Chico,CA 95928•CAL00082784e"' <br /> ❑ ALTERNATE FACILITY <br /> USED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE <br /> RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE This Is to certify th the above n$' d articles are propperly classified,described, packaged, marked <br /> and, <br /> d, and a In proper c h, ition for,transportatlon, according to the applicable regulations of <br /> 7 <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Dep // ransportatio � , <br /> *1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 PPM.; X <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTOMSSIGNATURE DATE <br /> *1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LtGAL 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 />