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FORM NO.AES003 <br /> SERVICE ORDER <br /> == = <br /> No. N 637492 <br /> �- ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S. SANTA FE AVENUE ❑ COMPTON, CALIFORNIA 90221 ❑ (310) 886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPA CAD028277036 1-888-603-8844 <br /> DATE -` ONETIME PICK UP -©YES or ❑NO <br /> CUSTOMER C"-,.;" - <br /> - RESIDENCE ❑ YES or D. <br /> BILLING ADDRESS CONTRACT CUSTOMER 01ES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE' CONTACT CUSTOMER NUMBER <br /> A.- <br /> CUSTOMER EPA# AMOUNT <br /> JOB SITE ADDRESS CHECK NUMBER <br /> P.O.NUMBER <br /> TS CASH RECEIVED <br /> CROSS STREETS (AMOUNT) <br /> NOTES: - COMMODITY <br /> HALIDES P.P.M. <br /> ❑ NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIL/MIXED OILS)STATE CODE 221 <br /> *NO PLACARDS REQUIRED* <br /> 4' NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE 133 <br /> *NO PLACARDS OR MARKINGS REQUIRED* NEXT SERVICE DATE <br /> Ll OTHER DRUMS DRUM SIZE <br /> MANIFEST NO. ` ,.'f. .r f'� "ti NO,OF GALLONS <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 /> CJ,-_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 This is to certify that the above named articles are properly classified, described, packaged, marked <br /> RF''YCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THEN and labeled,.and are in proper condition for transportation, acc&ding to the applicable regulations of <br /> BY CC EST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Department of Transportation. <br /> ^*1 REREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY c <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; X I I I <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTOMER SIGNATURE DATE <br /> %FORTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X PRINT <br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR <br /> CONTAINS ANY P.C.B'S. NAME <br />