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FORM NO. AES003 <br /> SERVICE ORDER <br /> NO. N ' <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE 0 COMPTON, CALIFORNIA 90221 ❑ (310) 885-3400 <br /> EPA#CAD028277036 <br /> DIXON UNION CITY CHICO FRESNO <br /> 806-727-2879 888-603-8844 800-733-9043 866-994-6937 <br /> DATE <br /> ONETIME PICK UP ❑YES or ❑NO <br /> CUSTOMER RESIDENCE ❑ YES or -- NO <br /> BILLING ADDRESS CONTRACT CUSTOMER 1-1 YES or ❑ NO <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 PM, <br /> ❑ NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIL/MIXED OILS)STATE CODE 221 <br /> *NO PLACARDS REQUIRED* <br /> .LJ NON-RCRA HAZARDOUS WASTE, LIQUO(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> *NO PLACARDS OR MARKINGS REQUIRED* NEXT SERVICE DATE <br /> ❑ OTHER DRUMS DRUM SIZE <br /> MANIFEST NO, C ,. Il l N0.OF GALLONS <br /> DRIVER TRUCK NO.&RT <br /> ❑ USED OIL AND GASOLINE FILTERS <br /> ❑ SA RECYCLING, 33210 Western Avenue,Union City,CA 94587 1-510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DE&GNATED TSDF: ❑ ASBURY ENVIRONMENTAL SERVICES•2549 Scot Avenue•Chico, CA 95928•CALOCC827844 <br /> 0 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+(80C)733-9043 <br /> E7 BAKERSFIELD TRANSFER INC_ •1620 F.Brundage Ln. •Bakersfield,CA 93307•CAL000282599•(661)377-0308 <br /> ❑ D/K DIXON•7300 Chevron Way• Dixon,CA 95620•CAT080012602•(707)693-6008 <br /> ❑ DEMENNO/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 •CA0044003556-(916)371-5747 <br /> ❑ WORLD OIL-SAN JOAQUIN,LLC•14287 E. Manning Ave. - Parlie,CA 93648•CALC00102751 •(559)498-0240 <br /> ❑ ALTERNATE FACILITY <br /> USED 01L,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE <br /> RECYCLED AT OUR SISTER COMPANY DEMENNq/KERDOON THE This is to certify that the above named articles are properly classified, described, packaged, marked <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. and labeled. and are in proper condition for transportation, according to the applicable regulations of <br /> the Department of Transportation. <br /> *I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> OTHFR WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 PP.M.; X ' ' l <br /> AND THATTHE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTOMER SIGNATURE BATF <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 />