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09/14/2010 13:57 4082622206 PANDCAUTO PAGE 02/06 <br /> FORM NO.AE5000 <br /> - _ - SERVICE ORDER <br /> No. N 684480 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S,SANTA FE AVENUE 0 COMPTON, CALIFORNIA 90221 CI (310) 886-3400 <br /> EPAfFCAD028277036 <br /> DIXON UNION CITY CHICO <br /> 800-727-2879 888.603-8844 600-733-9043 <br /> DATE / ONETIME PICK UP 0 YES or ❑NO <br /> CUSTOMER RESIDENCE ❑ YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or 1=1 NO <br /> PLEASE PAY FROM THIS <br /> r _ SERVICE ORDER <br /> PHONE 7, �'z ^7 % l CONTACT z CUSTOMER NUMBER <br /> CUSTOMER EPA# rte, • / /'r G' F,3 7r' ,� '.'>.• ? <br /> ,- AMOUNT <br /> JOB SITE ADDRESSr _ y�,. �'%' �- rj '. r' CHECK NUMBER <br /> NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES; (,: %77] <br /> COMMODITY r.` <br /> HALIDES PPM. <br /> FJ NON-RCRA HAZARDOUS WASTE, LIOUID(USED OIUMIXED OILS)STATE CODE_221 <br /> *NO PLACARDS REQUIRED* <br /> ❑ NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> *NO PLACARDS OR MARKINGS REQUIRED* NEXT SERVICE DATE <br /> :1 OTHER DRUMS DRUM SIZE <br /> MANIFEST NO, NO.OF-GALL-ONS i> > <br /> DRIVER <br /> TRUCK NO,&RT. ~�% r' •-` <br /> lam. USED OIL AND GASOLINE FILTERS <br /> ❑ SA RECYCLING, 33210 Western Avenue,Union City,"CA 94587 1-510-487-9277 <br /> F_1 ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ ASBURY ENVIRONMENTAL SERVICES•2549 Scot Avenue•Chico,CA 95928•CAL000827844 <br /> 0 ASBURY ENVIRONMENTAL SERVICES-CHICO II,LLC• 1618 W.5Th St„Chico.CA 95928-CAD980694103•(800)733-9043 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES-FORTUNA•200 Dinsmore Dr„ Fortuna,CA 95540•CAI-930256136•(800)733-9043 <br /> ❑ BAKERSFIELD TRANSFER INC. • 1620 E. Brundage Ln. • Bakersfield,CA 93307•CAI-000282598•(661)377-0308 <br /> 7_1 D/K DIXON•7300 Chevron Way•Dixon,CA 95620•CAT080012602•(7077)693-6008 <br /> ❑ DEMENNO/KERDOON•2000 N.Alameda Street•Compton,CA 90222•CAT080013352-(310)537-7100 <br /> n EVERGREEN ENV.•4139 N,Valentine Ave. - Fresno,CA 93722-CAD982446882-(510)795-1400 <br /> ❑ RAMOS ENVIRONMENTAL•1515 S.River Road•W,Sacramento,CA 95691 •CAD044003558•(916)371-5747 <br /> 0 ALTERNATE FACILITY _ <br /> USED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This i3 to certify that the above named articles.are property classllled, described, packaged, marked <br /> RECYCLED C OUR SISTER COMPANY D@M TERN UNITED <br /> ST THE and labeled,and are In proper Condition for transportation,according to the:,applicable regularlons of <br /> LARGEST RECYCLER OF USED OIL IN THE"STERN UNITED STATES, tho Department of TYarasportation. <br /> 11 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 PRM,; <br /> AND THATTHE WASTE DOES NOT CONTAIN ANY PC.B'S.. CUSTOMER SIGNATLJRf DATC <br /> '1 FURTHER AGREC TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL <br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR <br /> CONTAINS ANY P.C.6'$• PNINTNAMr=` <br />