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FORM NO. AES003 <br />SERVICE ORDER <br />No. N <br />ASBURY ENVIRONMENTAL SERVICES <br />1300 S. SANTA FE AVENUE ❑ 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 <br />ONETIME PICK UP El YES or ❑ NO <br />CUSTOMER <br />RESIDENCE ❑ YES or ❑ NO <br />BILLING ADDRESS <br />CONTRACT CUSTOMER ❑ YES or ❑ NO <br />PLEASE PAY FROM THIS <br />SERVICE ORDER <br />PHONE CONTACT <br />CUSTOMER NUMBER <br />CUSTOMER EPA # <br />AMOUNT <br />JOB SITE ADDRESS <br />CHECK NUMBER <br />P.O. NUMBER <br />CROSS STREETS <br />CASH RECEIVED <br />(AMOUNT) <br />NOTES: <br />COMMODITY <br />HALIDES P.P.M. <br />❑ NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIL/MIXED OILS) STATE CODE 221 <br />*NO PLACARDS REQUIRED* <br />❑ NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br />*NO PLACARDS OR MARKINGS REQUIRED* NEXT SERVICE DATE <br />❑ OTHER <br />MANIFEST NO. <br />DRIVER {` <br />❑ USED OIL AND GASOLINE FILTERS <br />❑ SA RECYCLING, 33210 Western Avenue, Union City, CA 94587 1-510-487-9277 <br />❑ ALTERNATE FACILITY <br />DRUMS DRUM SIZE <br />NO. OF GALLONS <br />TRUCK NO. & RT. <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 />p DAKERBFIELo TRAIJSFER Min_ 1 r,00 P Pr-H.O. I n . Raka fialrl. CA 933n7 • CAI nnn9R2598 • (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 • CAD044003556 • (916) 371-5747 <br />❑ WORLD OIL -SAN JOAOUIN, LLC • 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 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 />