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FORM NO.AES003 <br /> -- -- SERVICE ORDER <br /> - - . NO. N ,9026040'' <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE r❑ COMPTON,CALIFORNIA 90221' ❑ (310) 886=3400 <br /> EPA$CAD028277036 <br /> DIXON UNION CITY CHICO FRESNO, <br /> 800-727-2879 888-603-8844 800-733-9043 866-994-6937 <br /> DATE _- ONETIME PICKUP ❑YES or❑NO <br /> CUSTOMER RESIDENCE ❑YES or p NO <br /> BILLING ADDRESS' CONTRACT CUSTOMER C YES or'p NO <br /> PLEASE PAYFROM• S <br /> SERVICE ORDER <br /> PHONE � � 1 ! �6%�TACT CUSTOMER NUMBS - <br /> CUSTOMER EPA. 1 +� • l!V AMOUNT <br /> ' t <br /> JOB.SITE ADDRESS. CLAre(�D CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> f ou,�olT M . <br /> NOTES: Comm OOITY %./ <br /> HALIDES PPM.. <br /> �VNb <br /> N-RORA.HAZARDOUS WASTE,L QUID{USED OIIJMIXED OILS)STArF GLIDE1 <br /> PLACARVS REQUIRED" <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE COOP <br /> ,NO PLACARDS OR MARKINGS REOUIRtbr NEXT SERVICE DATE <br /> ❑ OTHER __ DRUMS QR%JM SIZE <br /> MANIFEST NO; ✓ NO.OF GALLONS ' d <br /> DRIVER_ rf,�-1 _ T _ TRUCK NO.&RT. <br /> ❑ USED OIL AND GASOLINE FILTERS <br /> El SA RECYCLING, 33210 Okslern Avenue,Union City,CA 94587 1-510-487-9277 0 <br /> ALTEI3PlATE FACILITY 7 <br /> IP2 S; <br /> DESIGNATED TSDF: ❑ ASBURY ENVIRONMENTALL S VICES•2549 Scot Avenue•Chico,CA 95928•CALW082784 4 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES-CHICO 11,LLC•1618 W.5th St.,Chico,CA 95928■CAD980694103•(000)733-9043 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES-FORTUNA■200 Dinsmore Dr.,Fortuna,CA 95549•CAL030256136■(1300)733-9013 <br /> ❑ BAKE RSFIELD TRANSFER INC, •1620 E.SrurldarJe Ln.■Bakersfield,CA 93307■CAL000282598•(661).377-0308 <br /> ❑ DIK DIXON.7304 Chevron Way•Dixon.CA 9 562 0•CAT080012602•(747)(593-6008 <br /> ❑ DEMENNOIKEERDOON•2000 N.Alameda Street•Campton,CA 90222•CAT080013352■(310)537-7100 <br /> ❑ EVERGRE 914 ENV.•4139 N.Valenline Ave.•Fresno,CA 113722 CAD982446882 i(510)7955-4400 <br /> ❑ RAMOS ENVIRONMENTAL■ 1515 S,River Road•W.Sacramento,CA 95691 •CAD044003556■(9'16)371-5747 <br /> ❑ WORLD OIL-SAN JOAQUIN,LLC■14287 E.Manning Ave.•Parlier•CA 93648•CAL000102751 •(559)498-0214 <br /> ❑ ALTERNATE FACILITY <br /> USED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to cerlity that the above hanged articles are pr !fly ciaxsifiad,described,packaged,marked <br /> RECYCLEp AT OUR SISTER COMPANY pEMENNO/KERDOON THE and labeled, and n5- o ker condition for in.mpartaon,according to the applicable reptllaElon's Or <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. theCrLparfrnent1 t1 <br /> 11 HERESY CERTIFY THAT.I HAVE NOT MIXED 11•IIS WASTE WITH ANY <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 PPM.; X <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY PC:B'S.. M oIGr4A7Ut0.E DA7E <br /> 11 FURTHER AGREETO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL <br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR X <br /> CONTAINS ANY P.C.B'S, P1ZV}W IFYMFa,� <br />