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FORM NO.AES003 <br /> z.r <br /> q �kAzSERVICE ORDER <br /> s. <br /> No. N 6493539 <br /> z z � F <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S SANTA FE AVENUE ❑ EOA#CAD0282771oORNIA 90221 ❑ (310) 8ECEIVED <br /> a <br /> Fr DIXON ; UNION CITY CHICO JAN 14 2011 <br /> 800-727-2879 888-603-8844 800-733-9043 <br /> ENVIRONMENTAL HEALTH <br /> DATE ONE TIMtF UOERVICP(ES or ❑NO <br /> CUSTOMER `' 0 "t �' ` °� �°a RESIDENCE ElYES or ElNO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> " ` PLEASE PAY FROM THIS <br /> SERVICE ORDER, <br /> PHONE <br /> " CONTACT CUSTOMER NUMBER '' ' '` <br /> CUSTOMER EPA# AMOUNT <br /> tl <br /> JOB SITE ADDRESS t `"°' I <br /> CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS L CASH RECEIVED <br /> -- (AMOUNT) <br /> NOTES: f COMMODITY <br /> a. A <br /> yV <br /> HALIDES P.P.M. <br /> ElNON-RCRA HAZARDOUS WASTE, LIQUID(USED OIL/MIXED OILS)STATE CODE 221 7 <br /> w <br /> *NO PLACARDS REQUIRED* N. <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 /> p <br /> DRIVER ]RUCK NO.&RT. <br /> 27 1 <br /> �. <br /> ❑ USED OIL AND GASOLINE FILTERS 7z,i <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,CA 95928•CAL000827844 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES-CHICO II,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 /> 1-1 DEMENNO/KERDOON•2000 N.Alameda Street•Compton,CA 90222•CAT080013352•(310)537-7100 <br /> R T ❑ EVERGREEN ENV.•4139 N.Valentine Ave.•Fresno,CA 93722•CAD982446882•(510)795-4400 <br /> ,ED RAMOS ENVIRONMENTAL• 1515 S.River Road•W.Sacramento,CA 95691 •CAD044003556•(916)371-5747 <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 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 />