Laserfiche WebLink
DATE <br />CUSTOMER <br />SERVICE ORDER <br />NO. N <br />ASBURY ENVIRONMENTAL SERVICES <br />2100 NORTH ALAMEDA STREET ❑ COMPTON, CALIFORNIA 90222 ❑ (310) 886-3400 <br />SAN DIEGO OFFICE NORTHERN CALIFORNIA <br />1-800-748-5744 EPA CA0028277036 1-800-727-2879 <br />ONE TIME PICK UP <br />RESIDENT <br />❑ YES or ❑ NO <br />❑ YES or ❑ NO <br />BILLING ADDRESS <br />CONTRACT CUSTOMER ❑ YES or ❑ NO <br />PHONE .' CONTACT <br />CUSTOMER NUMBER <br />CUSTOMER EPA # <br />AMOUNT <br />JOB SITE ADDRESS <br />CHECK NUMBER <br />❑ <br />P.O. NUMBER <br />CROSS STREETS <br />CASH RECEIVED <br />❑ <br />(AMOUNT) <br />NOTES: <br />COMMODITY <br />HALIDES P.P.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* <br />NEXT SERVICE DATE <br />❑ OTHER <br />DRUMS DRUM SIZE <br />MANIFEST NO. `( <br />NO. OF GALLONS <br />DRIVER <br />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: ❑ <br />ALVISO INDEPENDENT OIL - 5002 Archer Street • Alviso, CA 95502 • CAL000161743 • (510) 476-1740 <br />❑ <br />BAYSIDE OIL II, INC. • 210 Encinal Street • Santa Cruz, CA 95060 • CAD088838222 • (408) 427-3778 <br />❑ <br />PARLIER FACILITY • 14287 E. Manning o Parker, CA 93648 e CAL000102751 o (559) 498-0240 <br />❑ <br />DeMENNO/KERDOON • 2000 N. Alameda Street • Compton, CA 90222 • CAT080013352 • (310) 537-7100 <br />❑ <br />D/K DIXON . 7300 Chevron Way • Dixon, CA 95620 • CAT080012602 • (707) 693-6008 <br />❑' <br />RAMOS ENVIRONMENTAL . 1515 S. River Road . W. Sacramento, CA 95691 . CA0044003556 . (916) 371-5747 <br />❑ <br />ASBURY ENVIRONMENTAL SERVICES • 2549 Scott Avenue • Chico, CA 95928 • CAL000827844 <br />❑ <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 />RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled, and are in proper condition for transportation, according to the applicable regulations of <br />LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Department of Transportation. <br />*1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br />OTHER WASTE, THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; X <br />AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTOMER SIGNATURE DATE <br />*1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL 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 />