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FORM NO. AES003 <br />SERVICE ORDER <br />ASBURY ENVIRONMENTAL SERVICES <br />1300 S. SANTA FE AVENUE ❑ COMPTON, CALIFORNIA 90221 ❑ (310) 886-3400 <br />EPA# CAD028277036 <br />DIXON UNION CITY CHICO <br />800-727-2879 888-603-8844 800-733-9043 <br />DATE ONE TIME PICKUP ❑ YES or ONO' <br />CUSTOMER :} 't RESIDENCE ❑ YES or N® <br />BILLING ADDRESS CONTRACT CUSTOMER ' ET YES or ❑ NO <br />PLEASE PAY FROM THIS <br />SERVICE ORDER <br />�w <br />PHONE ` CONTACT CUSTOMER NUMBER <br />CUSTOMER EPA# " '1 r AMOUNT <br />JOB SITE ADDRESS z a ." CHECK NUMBER <br />' t P.O. NUMBER <br />CROSS STREETS GASH RECEIVED; <br />1170UNT) <br />—i <br />NOTES:"CoMMOF)ITY .. n <br />HALIDES"P.P.M. <br />❑ NON-RCRA HAZARDOUS WASTE, LIQUID (USED OILJMIXED OILS) STATE CODE 221 <br />*NO PLACARDS REQUIRED* <br />D"` NON-RCRA RDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br />*NO PLACARDS OR MARKINGS REQUIRED* NEXT SERVICE DATE <br />OTHER DRUMS DRUM SIZE <br />MANIFEST NO. <br />NO. OF GALLONS <br />Wa' <br />DRIVER TRUCK NO. & RT.: <br />❑' USED OIL ANIS GASOLINE FILTERS <br />❑ SA RECYCLING, 33210 Western Avenue, Union City, CA 94587 1-510-487-9277 <br />❑ ALTERNATE FACILITY <br />DESIGNATED TSDF: ❑ ASBURY ENVIRONMENTAL SERVICES • 2549 Scot Avenue • Chico, GA 95928 • CAL000827844 <br />❑ ASBURY ENVIRONMENTAL SERVICES-CHICO II, LLC • 1618 W. 5th St., Chico, CA 95928 • CAD980694108 • (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 />DEMEN O/KERDOON + 2000 N. Alameda Street ® Compton, 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 />b SAN JOAQUIN FILTER RECYCLING • 14287 E. Manning Ave. • Parlier, CA 93648 • CAL000102751 • (559) 498-0240 <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 <br />DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M. TOTAL HALIDES, OR <br />CONTAINS ANY P.C.B'S. PRINT NAME <br />