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C'40cb0n FORM NO.AES003 <br /> SERVICE ORDER <br /> .— — No. N 653533 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE o COMPTON,CALIFORNIA 90221 o (310)886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPA CAD028277036 1-888.603-8844 <br /> DATE / :? �' ` ONE TIME PICK UP DYES or ENO <br /> CUSTOMER j'' j7- �'. ' ':!, ;-F i9�l <br /> RESIDENCE ❑ YES or NO <br /> r <br /> BILLING ADDRESS ~ - I,. ' r'�� t'7�?�y`�T,�' ! - 4��!-{� CONTRACT CUSTOMER <br /> - Q)ES or ❑ NO <br /> T r r PLEASE PAY FR6M THIS <br /> ! _ f SERVICE ORDER <br /> PHONE !,' �-,> �;`�f CONTACT ftr�//�'r ` +'' CUSTOMER NUMBER <br /> CUSTOMER EPA# r :''� r ) !f �:` AMOUNT <br /> JOB SITE ADDRESS CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> TES: �f` � �. % } <br /> r COMMODITY <br /> HALIDES P.P.M. <br /> us NON-RCRA HAZARDOUS WASTE,L QUID(USED OIL/MIXED OILS)STATE CODE 221 <br /> *NO PLACARDS REQUIRED* <br /> ❑ NON-RCRA HAZARDOUS WASTE,Lt UID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE 133 <br /> *NO PLACARDS OR MARKINGS RE UIRED* NEXT SERVICE DATE <br /> ❑ OTHER DRUMS DRUM SIZE <br /> MANIFEST NO. .!` --L— <br /> DRIVER <br /> - -w <br /> NO.OF GALLONS % <br /> DRIVER <br /> TRUCK NO.R RT. :_7.._._ <br /> ❑ NON HAZARDOUS DRAINED USED IL Fll-TER <br /> ❑ COMMERCIAL FILTER RECYCLING, 10 Western Avenue,Union City,CA,510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ BAKERSFIELD RANSFER INC.-1620 E.Brundage Ln.•Bakersfield,CA 93307•CAL000282598•(661)377-0308 <br /> ❑ BAYSIDE OIL II INC.*210 Encinal Street•Santa Cruz,CA 95060*CA0088838222*(831)427.3773 <br /> ❑ EVERGREEN NV.•4139 N.Valentine Ave.•Fresno, CA 93722.CAD982446882•(510)795-4400 <br /> ❑- DEMENNO/KER OON 2000 N.Alameda Street•Compton,CA 90222•CAT080013352•(310)537-7100 <br /> ❑ DIK DIXON•73 0 Chevron Way.Dixon,CA 95620•CAT080012602•(707)693-6008 <br /> p RAMOS ENVIR NMENTAL.1515 S.River Road *W.Sacramento,CA 95691.CAD644003556 .(916)371.5747 <br /> �'❑ ASBURY ENVIR NMENTAL SERVICES•2549 Scott Avenue*Chico,CA 95928•CAL000827844 <br /> ❑ ALTERNATE F ILITY <br /> t''— 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 /> CLED AT OUR SISTER COMPANY DE ENNO/KERDOON THE and labeled,and are in proper condition for transportation,according to the applicable regulations of <br /> L_ aEST RECYCLER OF USED OIL IN THE WE TERN UNITED STATES. the Department of Transportation. ! <br /> .1 <br /> *1 HEREBY CERTIFY THAT I HAVE NOT MIXED IS WASTE WITH ANY �^�r� ""? + { , '• ',`� <br /> I ' y <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE ESS THAN 1000 P.P.M.; X t ,•_;,,�..«,�-•- � t �:�d'�L �i,,f•.,,, � � ` ��,. <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY .C.B'S.. cuSrOMR$IGNAiuRE DATE <br /> *1 FURTHER AGREE TO ACCEPT THE ADDITIONA CHARGES FOR LEGAL qq tf J <br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P. TOTAL HALIDES, OR X +; °� ! 1 t IR <br /> p <br /> CONTAINS ANY P.C.B'S. rmlNF NAME <br /> i <br />