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FORM NO. AES003 <br />:� a SERVICE ORDER <br />No. N 718462 <br />ASBURY ENVIRONMENTAL SERVICES <br />1300 S. SANTA FE AVENUE D COMPTON, CALIFORNIA 90221 0 (310) 886-3400 <br />EPA# CAD026277036 <br />DIXON UNION CITY CHICO <br />800-727-2879 888.803-8844 800-733-9043 <br />DATE <br />CUSTOMER <br />BILUNG ADDRESS <br />PHONE - - I X rr !. I,CONTACT <br />CUSTOMER EPA # ri Q G (: ` I L -A,, _T <br />JOB SITE ADDRESS _ �i . d I - t- t-1 Y n ✓ 7w <br />CROSS STREETS <br />ONE TIME PICKUP <br />RESIDENCE <br />DYES or ONO <br />O YES or O ­_NO <br />CONTRACT CUSTOMER ETYES or ONO <br />PLEASE PAY FROM THIS <br />SERVICE ORDER 7 <br />CUSTOMER NUMBER <br />AMOUNT <br />CHECK NUMBER _ <br />P.O. NUMBER <br />CASH RECEIVED _ <br />COMMODITY_ <br />i <br />HALIDES <br />.9--KON-RCRA HAZARDOUS WASTE, LIQUID (USED ORLMIXED OILS) STATE COOS 221 <br />'NO PLACARDS REQUIRED' <br />❑ NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br />NO PLACARDS OR MARKINGS REWIRED' NEXT SERVICE DATE <br />❑ OTHER DRUMS DRUM SIZE <br />MANIFEST NO. Ii r �' NO. OF GALLONS /y <br />DRIVER �� TRUCK NO.8 RT ~/ <br />O USED OIL AND GASOUNE FILTERS / <br />❑ SA RECYCLING, 33210 Weslem Avenue. Urifon City, CA 94587 1-510-487-9277 <br />❑ ALTERNATE FACILITY <br />DESIGNATED TSDR ❑ ASBURY ENVIRONMENTAL SERVICES • 2549 Scot Avenue • Chico. CA 95928 • CAL000827844 <br />❑ AS IJRY ENVIRONMENTAL SERVICES-CHICO 11, LLC • 1618 W. SM St., Chico, CA 95928 • CAD980694103 • (800) 733.9043 <br />❑ ASBURY ENVIRONMENTAL SERVICES-FORTUNA • 200 Dinsmore Dr., Fortuna. CA 95540 • CAL93WS6136 • (800) 733-9043 <br />❑ BAKE SIFEAD TRANSFER INC. • 1620 E Brundage Ln. • Bakersfield, CA 93307 • CAL000282598 • (661) 377-0308 <br />❑ D/K MON • 73M Chevron Way • Dixon. CA 95620 • CAT08001 2 602 • (707) 693-0008 <br />❑ DEMENNO/KEADOON • 2000 N. Alameda Street • CwVton, CA 90222 • CAT080013352 • (310) 537-7100 <br />fr ❑ E1 <br />MOR ENV. • 4139 N. VolenOne Ave. • Fresno, CA 93722 • CAD982446882 • (510) 795-4400 <br />r•+' MOS ENVIRONMENTAL • 1515 S. River Road • W. Sauamento, CA 95691 • CAD044003556 • (916) 371-5747 <br />❑ SAN JOAQUIN RLTF,R RECYCLING • 14287 E. Manning Ave. • Pallier, CA 93845 • CAL000102751 • (5591498-0240 <br />❑ ALTERNATE FAOLITY <br />USED OIL, USED ANTIFREEM AND OILY WATER WASTE STREAMS ARE This Is to mbly that the above named aradee are ad daaU6eQ descrl0ed, pedtaSed maMed <br />LARGEST R CYCLER OF USED OIL N THE WESTERN UNITED STATES. and labeled, arN are n proper corgNion for trensWfabon, property <br />to the appica01e ret ufadms of <br />Ola Diable"ern of TravpMalion. <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 �_ ��-�.- ?.�y <br />AND THATTHE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTOMER SIGNATURE <br />'I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL n /J / <br />DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M. TOTAL HALIDES, OR X A am A., £i'R>r-�-^` <br />CONTAINS ANY P.C.B'S. m'wuAE - <br />