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FORM NO.AES003 <br /> -• = SERVICE ORDER <br /> NO.• N 905. 4.172 <br /> ASBURY ENVIRONMENTAL-SERVICES <br /> 11,300 S.SANTA FEAVENUE ❑ COMPTON,CALIFORNIA 902'21 6' (310) 886-3400 <br /> 1 EPA#CAD028277036 <br /> ,i <br /> DIXON UNION CITY CHICO FRESNO <br /> 800-727-2879 888-603=8844 800-733=9043 866-994-6937 <br /> DATE ONETIME PICKUP OYES or ❑NO <br /> ESIDENCE ❑YES or. ❑ NO <br /> CLISTOMiR <br /> �-. , . _ - - <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑YES or ❑'NO <br /> F'�IQNE <br /> t7-C CONTACT' CUSTOMER NUMBER <br /> • .. <br /> CUSTOMER;EPA!r' •• .1 . AMOUNT. <br /> JOB SITE ADDRESS r� - G� CHECK NUMBER <br /> P.O.NUMBER <br /> -CA'SH•RLCE <br /> CROSS'STREEf$ - . . I11�D <br /> , <br /> - — (AMOUNT) <br /> NOTES: -COMMODITY <br /> ' HALIDES P P M. <br /> NON-RCRA HAZARDOUS WASTE,.LIQ UID(USED OIL/MIXED:OILS)STAJE•,CODE 223' _ <br /> *NO PLACARDS REQUIRED* <br /> ON=RCRA HAZARDOUS.WASTE,LIQUIQi(ETHYLENE GLYCOL SOLUTIONS)STATE CODE <br /> *NO PLACARDS Ort MARKINGS REQUIRED* NEXT SERVICE DATE <br /> OTHER DRUMS DRUM SIZE <br /> MANIFESTNO. NO:.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 /> 0 <br /> -510-487-9277•❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ ASBURY ENVIRONMENTAL SERVICES•2549 Scot Avenue i Chico,CA 95928•CAL000827844 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES-CHI,CO II,LLC- 1618 W.5th.St.,Chico,CA 95928•CAD-0806941103•(800)733.9043 <br /> F1 ASBURY ENVIRONMENTAL SERVICES-FORTUNA 200 Dinsmore Dr.,Fortuna,CA 1955.10:CAL930256'1313•(A00)733-9043 <br /> ❑ BAKERSFIELD TRANSFER INC. • 1620 E.Brundage Ln.•Bakersfield,CA 93307%CAL000282598•(661)377-0308 <br /> [ID/K DIXON•7300 Chevron Way•Dixon,CA 95620 P CAT0800.12602•(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 s 1515 S.River Road•W.Sacramento,CA 95691 •CAD04.1003556•(916)371.5777 <br /> ❑ WORLD OIL-SAN JOAQUIN,LLC•14287 E.Manning Ave.•,Parller,CA 936.16•CAL000102751 •(559)498-02,10 <br /> ❑ ALTERNATE FACILITY <br /> USED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to Certify that the above named w6rdns aria Waperly Cfaa5irio4, describux1,packagL.d,marked <br /> RECYCLED AT OUR SISTER COMPANY DEMENNOIKERDOON THE and abetad,and are in proper condition for Ironrpwlrnlon,according to Iho appfrcable rergulatlarfs of <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Jk�+Ir t Tans r irinrr, <br /> *1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1.000 P.P.M.; X L <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTDMER 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 PC B'S. — PRIPT NAMF <br />