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ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOES002-D (1/17) <br /> FOR SERVICE CALL: AERM <br /> PARLIE'R ImSERVICE ORDER <br /> 559-498-0240 <br /> ELAN <br /> FOR 562-231 1550 TING CALL: WORLD ORLD OIL No. N ' c <br /> ENVIRONMENTAL SERVICES- <br /> 14267 EAST MANNING AVE ❑ PARLIER,CALIFORNIA 93648 o (559)498-024D <br /> EPA#CAD029277036 <br /> DATE " CUSTOMER NUMBER <br /> CUSTOMER AMOUNT <br /> PHONE .` CONTACT CHECK NUMBER <br /> CUSTOMER EPA# :. f P.O.NUMBER <br /> JOB SITE ADDRESS y CASH RECEIVED <br /> — (AMOUNT) <br /> COMMODITY <br /> CROSS STREETS HALIDES P.P.M. <br /> NOTES: <br /> D, NON-RCRA.HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS)STATF CODE 221 <br /> *NO PLACARDS REQUIRED* <br /> ❑ NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE <br /> *NO PLACARDS OR MARKINGS REQUIRED* NEXT SERVICE DATE <br /> ❑ OTHER DRUMS DRUM SIZE <br /> MANIFEST NO. NO.OF GALLONS <br /> DRIVER TRUCK NO.&RT. V s <br /> ❑ USED OIL AND GASOLINE FILTERS <br /> ❑ BIG SKY ENTERPRISES, 401 West Channel Rd.,Benicia,CA 9451 D CAL 000301639 1-510-541-2128 <br /> ❑ GLOBAL MATERIAL MANAGEMENT, 1640 N.Broadway Ave.,Stockton,CA 95205 CAL 000417316 1-818-770-2577 <br /> ❑ SA RECYCLING, 33210 Western Avenue,Union City,CA 94587 1-510-487-9277 <br /> ❑ YUMA YES LLC, 2730 E.13th Street,Yuma,AZ 85365 AZR000515924 1-928-643-8938 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ ASBURY ENVIRONMENTAL SERVICES•2549 Scot Avenue•Chico,CA 95928•CAL000827844 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES-CHICO 11,LLC• 1618 W.5th St.,Chico,CA 95928•CAD980694103•(800)733-9043 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES-FORTUNA•200 Dinsmore Dr,Fortuna,CA 95540•CAL930256136•(800)733-9043 <br /> ❑ BAKERSFIELD TRANSFER INC. •1620 E. Brundage Ln. +Bakersfield,CA 93307•CAL000282598•(661)377-0308 <br /> ❑ D/K DIXON•7300 Chevron Way+Dixon,CA 95620•CAT080012602•(707)693-6008 <br /> ❑ DEMENNO/KERDOON•2000 N.Alameda Street•Campton,CA 90222•CAT080013352•(310)537-7100 - <br /> ❑ EVERGREEN ENV.•4139 N.Valentine Ave.•Fresno,CA 93722•CAD982446882•(510)795-4400 <br /> ❑ RAMOS ENVIRONMENTAL• 1515 S.River Road•W.Sacramento,CA 95691 •CAD044003556•(916)371-5747 <br /> ❑ WORLD OIL-SAN JOAQUIN,LLC•14287 E.Manning Ave.-Parlier,CA 93648•CAL000102751 •(5,59)498-0240 <br /> Ow ALTERNATE FACILITY77 <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 1060 P.P.M.; X <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.US- 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 />