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FORM NO.AES003 <br /> SERVICE ORDER <br /> �- = NO. N - <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.:SANTA FE AVENUE ❑ COMPTON, CALIFORNIA 90221 ❑ (310) 886-3400 <br /> SAN DIEGO OFFIICE NORTHERN CALIFORNIA <br /> 1-800-748-5744 EPA CAD028277036 1-800-727-2879 <br /> DATE ONETIME PICK UP DYES or ❑NO <br /> CUSTOMER RESIDENCE ❑ YES or ❑ 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 P.P.M. <br /> ❑ NON-RCRA HAZARDOUS WASTE, LI UID(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 REQyIRED* NEXT SERVICE DATE <br /> ❑ OTHER DRUMS DRUM SIZE <br /> MANIFEST NO. NO.OF GALLONS <br /> DRIVER r TRUCK NO.&RT. <br /> ❑ NON HAZARDOUS DRAINED USED 0 L FILTER <br /> ED COMMERCIAL FILTER RECYCLING,3 210 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• (408)427-3778 <br /> ❑ EVERGREEN ENV. •4139 N. Valentine Ave. • Fresno, CA 93722- CAD982446882• (510) 795-4400 <br /> ❑ DEMENNO/KER OON •2000 N.Alameda Street•Compton., CA 9022.2•CAT080013352•(310)537-7100 <br /> ❑ 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 ENVIR NMENTAL SERVICES•2549 Scott Avenue•Chico,CA 95928•CAL000827844 <br /> ❑ ALTERNATE FA ILITY <br /> USED OIL,USED ANTIFREEZE AND OILY WATER ASTE STREAMS ARE This is to certify that the above named articles are properly classified, described, packaged, markec <br /> RECYCLED AT OUR SISTER COMPANY DEM NNO/KERDOON THE and labeled, and are in proper condition for transportation,according to the applicable regulations o' <br /> LARGEST RECYCLER OF USED OIL IN THE WES ERN UNITED STATES. the Department of Transportation. <br /> *1 HEREBY CERTIFY THAT I HAVE NOT MIXED T IS WASTE WITH ANY <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 PPM.' X <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY C.B'S.. CUSTOMER SIGNATURE DATE <br /> *1 FURTHER AGREE TO ACCEPT THE ADDITIONAd CHARGES FOR LEGAL X <br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M1.TOTAL HALIDES, OR <br /> CONTAINS ANY P.C.B'S, PRINT NAME <br />