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,,�pl��l Sri - i�6�• Zy7 _ �f-S <br /> FORM NO.AES003 <br /> SERVICE ORDER <br /> 0 <br /> *S <br /> it Pies M rah) Fc_�,r S = = == — NO. N 637493 <br /> _9�satX w N,60 ASBURY ENVIRONMENTAL SERVICES <br /> 1—�, 1300 S. SANTA FE AVENUE ❑ COMPTON, CALIFORNIA 90221 11 (310) 886-3400 <br /> I� Z N DIXON UNION CITY <br /> 1-800-727-2879 EPA CAD028277036 <br /> 1'', <br /> '� 1-888-603-8844 <br /> DATE <br /> ONETIME PICK UP ❑YES or O NO <br /> CUSTOMER RESIDENCE ❑ YES or [T NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE CONTACT CUSTOMER NUMBER <br /> CUSTOMER EPA# AMOUNT <br /> JOB SITE ADDRESS CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY <br /> HALIDES .•,r° PP._M. <br /> ❑ `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 /> MANIFEST NO. ,` ' ` '•': NO.OF GALLONSi <br /> DRIVER TRUCK NO.&HT. <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 /> ❑ BAYSIDE OIL II,INC.•210 Encinal Street•Santa Cruz, CA 95060•CAD088838222•'(831) 427-3773 <br /> ❑ EVERGREEN ENV. .4139 N. Valentine Ave. • Fresno, CA 93722 .CAD982446882• (510) 795-4400 <br /> ❑ DEMENNO/KERDOON *2000 N.Alameda Street*Compton, CA 90222*CAT080013352*(310)537-7100 <br /> q 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 .(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 <br /> RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE This is to certify that the above named articles are properly,classified, described, packaged, marked <br /> .EST RECYCLER OF USED OIL 1N THE WESTERN UNITED STATES. and labeled, and are in proper condition for transportation,according to the applicable regulations of <br /> the Department of Transportation. <br /> CERTIFY THAT IITH AN <br /> OTfPiEREBY WAS E,THAT'THETO ALEHALIDES ARE LESS THANNT MIXED THIS 1000 0 P..P.MY X <br /> AND THAT THE WASTEDOES NOT CONTAIN ANY P.C.B'S.. x �,, I l <br /> *1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL CUSTOMER SIGN E DATE. <br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR X <br /> CONTAINS ANY P.C.B'S, <br /> PRINT NAME <br />