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FORM NO.AES003 <br /> SERVICE ORDER <br /> No. N 6363 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE o COMPTON,CALIFORNIA 90221 o (310) 886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPA CAD028277036 1-888-603-8844 <br /> DATE ONETIME PICK UP DYES or ❑NO <br /> CUSTOMER z 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, LI 1D(ETHYLENE GLYCOL SOLUTIONS)STATE CODE 133 <br /> *NO PLACARDS OR MARKINGS REQ IRED* NEXT SERVICE DATE <br /> ❑ OTHER DRUMS DRUM SIZE <br /> MANIFEST NO. � <br /> / ,�~: (� F .�.. ! _ NO.OF GALLONS ' -.. <br /> DRIVER TRUCK NO.&RT <br /> ❑ NONHAZARDOUS DRAINED USED OI FILTER <br /> ❑ COMMERCIAL FILTER RECYCLING,3 210 Western Avenue,Union City,CA,510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ ALVISO INDEPE DENT OIL-5002 Archer Street•Alviso,CA 95502•CAL000161743•(510)476-1740 <br /> ❑ BAYSIDE OIL II, 1JC.•210 Encinal Street•Santa Cruz,CA 95060•CAD088838222•(831) 427-3773 <br /> ❑ EVERGREEN El V. •4139 N. Valentine Ave. • Fresno, CA 93722.CAD982446882• (510)795-4400 <br /> Q DEMENNO/KERD DON •2000 N.Alameda Street•Compton,CA 90222•CAT080013352•(310) 537-7100 <br /> ❑ D/K DIXON•730 1 Chevron Way•Dixon,CA 95620•CAT080012602•(707)693-6008 <br /> ❑ RAMOS ENVIRO MENTAL.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 /> )SED OIL,USED ANTIFREEZE AND OILY WATERWASTE STREAMS ARE This is to certify that the above named articles are properly classified,described, packaged, marked <br /> iECYCLED AT OUR SISTER COMPANY DEMI NNO/KERDOON THE and labeled,and are in proper condition for transportation,according to the applicable regulations of <br /> ARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Department"of Transportation. <br /> I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> )THER WASTE,THAT THE TOTAL HALIDES ARE L ESS THAN 1000 P.P.M.; X I <br /> kND THAT THE WASTE DOES NOT CONTAIN ANY F C.B'S.. CUSTOMER SIGNATURE DATE <br /> I FURTHER AGREE TO ACCEPT THE ADDITIONAL HARGES FOR LEGAL X <br /> )ISPOSAL IF THIS WASTE IS OVER 1000 RPM TOTAL HALIDES, OR <br /> :ONTAINS ANY P.C.B'S. PAINT NAME <br />