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09/14/2010 13:57 4082622206 PANDCAUTO PAGE 04/06 <br /> I'ORM 1,40,ACSO03 <br /> SERVICE ORDER <br /> No. N 684481 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE r-1 COMPTON. CALIFORNIA 90221 ❑ (310) 886.3400 <br /> EPA#CAD028277036 <br /> DIXON UNION CITY CHICO <br /> 800-727.2879 8BB-603-8844 800-733-9043 <br /> DATE ` ONETIME PICK UP El YES or ONO <br /> i 1 <br /> RESIDENCE O YES or ❑ NO <br /> CUSTOMER <br /> BILUNG ADDRESS CONTRACT CUSTOMER ❑ YES or U NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE f '{1W' CONTACT r,.. CUSTOMER NUMBER <br /> Til. 7 AMOUNT <br /> CUSTOMER EPA# <br /> JOB SITE ADDRESS x' �r � ��•�-T�c%f �' CHECK NUMBER <br /> G <br /> ._ �..� <br /> PO.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY <br /> HALIDES PP.% <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(USED OILIMIXED OILS)STATE CODE_221 <br /> *NO PLACARDS REQUIRED* <br /> Ij NON-RCRA HAZARDOUS WASTE.UOUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE NEXT SERVICE DATE <br /> *NO PLACARDS OR MARKINGS REQUIRED �.� <br /> OTHER ��,.� ., .•�J•..,, �::�i 1,�r. 1 1 t s" n:r i DRUMS DRUM SIZE <br /> 1 c` <br /> MANIFEST NO. NO.OF GALLONS <br /> DRIVER TRUCK NO.&RT. <br /> ❑ USED OIL AND GASOLINE FILTERS <br /> ❑ SA RECYCLING, 33210 western Avenue,Union City,CA 94587 1-510-487-9277 <br /> ❑ ALTERNATE FACILITY - 111 <br /> DESIGNATED TSDF: E] ASBURY ENVIRONMENTAL SERVICES•2549 Scot Avenue•Chico,CA 95928•CAL000827844 <br /> ASBURY ENVIRONMENTAL SERVICES-CHICO II,LLC•1618 W.5th St.,Chico,CA 95928•CAD980694.103•(800)733-9043 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES-FORTUNA-200 Dinsmore Dr.,Fortuna,CA 95540•CAL930256136•(800)733.9043 <br /> h BAKERSFIELD TRANSFER INC. •1620 F_.Brundage Ln.•Bakersfield,CA 93307•CAL000282598•(661)377.0308 <br /> ❑ D/K DIXON•7300 Chevron Way•Dixon,CA 95620-CAT080012602 •(707)693-6008 <br /> ❑ DEMENNO/KERDOON•2000 N.Alameda Street•Compton,CA 90222•CAT080013352•(310)537-7100 <br /> F1 EVERGREEN ENV.•4139 N.Valentine Ave.•Fresno,CA 93722•CAD98244.6882•(510)795-4400 <br /> ❑ RAMOS ENVIRONMENTAL•1515 S.River Road-W.Sacramento,CA 95691 •CAD044003556■(916)371-5747 <br /> ❑ ALTERNATE FACILITY <br /> USED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to certify thit the above named article are.pro IV classified,described• packsgod, marked <br /> RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled•and are In proper condition for,trandportallon, acrording to the'appllonble regulations oT <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. ihri Department of Transporlallon, "" <br /> *1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY �f = <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 PRM'.; X <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY RC.B'S., e. ' CUSToMER:8IGNATURE DATE <br /> •1 FURTHER AGREETO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X --'' 1.f (f�� <br /> DISPOSAL IF THIS WASTE IS OVER 1000 RP.M.TOTAL HALIDES,.On PRINT NAME <br /> CONTAINS ANY PC.B'S. <br />