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-OkM NU.Ah�UW <br /> SERVICE ORDER <br /> No. N 66CD25 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S. SANTA FE AVENUE ❑ COMPTON, CALIFORNIA 90221 ❑ (310) 886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPA CAD028277036 1-888-603-8844 <br /> DATE r`t/'..- = ONETIME PICK UP El YES or E?NO <br /> CUSTOMER ,r'>.r a✓i �,y�..'o • I RESIDENCE El or a'NO <br /> of � <br /> BILLING ADDRESS - CONTRACT CUSTOMER El YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE - ;5"i L'dra.''•- ' +;-+ CONTACT CUSTOMER NUMBER <br /> CUSTOMER EPA# .'r' T } :/, ";'> ,- '' AMOUNT <br /> JOB SITE ADDRESS �'''-' " n.•r:.£.trl:t '' ev". CHECK NUMBER <br /> a <br /> " " %°"~'.fii n+'•' P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> ES: COMMODITY <br /> HALIDES -PPM. <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 133r <br /> NO PLACARDS OR MARKINGS REQUIRED' NEXT SERVICE DATE I <br /> ❑ OTHER DRUMS DRUM SIZE <br /> MANIFEST NO. + t v71 GCS% PC NO.OF GALLONS + . '+ <br /> DRIVER G -- n' TRUCK NO.&RL 'S'•1' <br /> ❑ NONHAZARDOUS DRAINED USED OIL FILTER <br /> ❑ COMMERCIAL FILTER RECYCLING,33210 Western Avenue, Union City,CA,510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ BAKERSFIELD TRANSFER INC.-1620 E.Brundage Ln.•Bakersfield,GA 93307•CAL000282598•(661)377-0308 <br /> ❑ BAYSIDE OIL 11,INC.•210 Encina)Street•Santa Cruz,CA 95060•CAD088838222•(831) 4273773 <br /> ❑ EVERGREEN ENV. .4139 N. Valentine Ave. • Fresno,CA 93722 •CA0982446882• (510)795-4400 <br /> ❑ DEMENNO/KERDOON •2000 N.Alameda Street•Compton,CA 90222•CAT080013352•(310)537-7100 <br /> p;. D/K DIXON•7300 Chevron Way•Dixon,CA 95620•CAT080012602•(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL.1515 S.River Road •W.Sacramento,CA 95691 .CAD044003556 .(916)371-5747 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES•2549 Scott Avenue•Chico,CA 95928•CAL000827844 <br /> ❑ ALTERNATE FACILITY <br /> 41MOIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to certify that the above named articles are properly classified, described,packaged marked, <br /> LED AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled, and are in proper condition for transportation, according to the applicable regulations of ' <br /> ST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Department.of Transportation. <br /> `I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> .OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 PPM; X <br /> AND THATTHE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTOMER SIGNATURE DATE 4 <br /> •I.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 /> PRINT NAME <br /> CONTAINS ANY P.C.B'S. ;"s, <br />