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,�-At�w FORM NO.AES003 <br /> SERVICE ORDER <br /> _ - No. N 128376 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 .SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221 ❑ (310)886-3400 <br /> SAN DIEGO OFFICE NORTHERN CALIFORNIA <br /> 1-800-748-574 EPA CAD028277036 1-800-727-2879 <br /> DATE - ONE TIME PICK UP ❑YES or ❑NO <br /> CUSTOMER '° '' -'' RESIDENCE <br /> ❑ YES or El NO <br /> BILLING ADDRESS %l CONTRACT CUSTOMER ❑-YES or ❑ NO <br /> N� _ <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> - - <br /> PHONE:'' fir,• ''•� CONTACT '?r;�r;%r'' W CUSTOMER NUMBER <br /> 1 <br /> CUSTOMER EPA# AMOUNT <br /> JOB SITE ADDRESS CHECK NUMBER <br /> ✓" t�^ ,rd.? .` .j r P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> ')TES: COMMODITY <br /> HAUDES RPM. <br /> ❑; NON-RCRA HAZARDOUS WASTE,LI UID(USED OIL/MIXED OILS)STATE CODE 221 <br /> *NO PLACARDS REQUIRED* <br /> '❑ NON-RCRA HAZARDOUS WASTE,U UID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE 133 <br /> *NO PLACARDS OR MARKINGS RE UNRED* NEXT SERVICE DATE <br /> ❑ OTHER DRUMS DRUM SIZE <br /> MANIFEST NO. NO.OF GALLONS C <br /> DRIVER "TRUCK NO.&RT. 1 , <br /> ❑ NON HAZARDOUS DRAINED USED 1L FILTER <br /> ❑ COMMERCIAL FILTER RECYCUNG, 3210 Western Avenue,Union City,CA,510-487-9277 <br /> ❑ ALTERNATE FACIUTY <br /> DESIGNATED TSOF: ❑ ALVISO INDEPENDENT OIL-5002 Archer Street Alviso,CA 95502•CAL000161743•(510)476-1740 <br /> ❑ BAYSIDE OIL IIS INC.•210 Encinal Street•Santa Cruz,CA 95060•CAD088838222•(408)427-3778 <br /> ❑ EVERGREEN ENV.-4139 N.Valentine Ave.-Fresno,CA 93722-CAD982446882-(510)795-4400 <br /> ❑ DEMENNO/KER60ON •2000 N.Alameda Street•Compton,CA 90222•CAT080013352-(310)537.7100 <br /> ❑ DfK DIXON-7300 Chevron Way-Db(on,CA 95620-CAT080012602-(70T)693-6008 <br /> D., RAMOS ENVIRd NMENTAL.1515 S.River Road .W.Sacramento,CA 95691.CA0044003556 *(916)371-5747 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES•2549 Scott Avenue-Chico,CA 95928•CAL000827844 <br /> ❑ ALTERNATE F IUTY <br /> -0 OIL,USED ANTIFREEZE AND OILY WATE WASTE STREAMS ARE This is to certify that the above named articles are properly classified,described, packaged,marked <br /> YCLED AT OUR SISTER COMPANY DE ENNOIKEROOON THE and labeled,and are in proper condition for transportation,according to the applicable regulations of <br /> - .,.1GEST RECYCLER OF USED OIL IN THE WE ERN UNITED STATES. the Department of Transportation. <br /> *1 HEREBY CERTIFY THAT I HAVE NOT MIXED HIS 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 PCB'S.. CUSTOMER SIGNATURE CATE <br /> *1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P. .TOTAL HALIDES, OR I <br /> CONTAINS ANY P.C.B'S. PRINT NAME <br /> • t <br /> I <br />