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FORM NO.AES003 <br /> SERVICE ORDER <br /> NO. N ' � $ <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S. SANTA FE AVENUE 0 COMPTON,CALIFORNIA 90221 0 (310) 886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPA CgD028277036 1-888-603-8844 <br /> DATE <br /> ONETIME PICKUP DYES or ❑NO <br /> CUSTOMER jr <br /> .-� RESIDENCE ❑ YES or ❑ NO <br /> 1 . <br /> BILLING ADDRESS <br /> CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE ' ' CONTACT / CUSTOMER NUMBER <br /> CUSTOMER EPA# r, <br /> AMOUNT <br /> JOB SITE ADDRESS CHECK NUMBER <br /> r6 PO.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY <br /> HALIDES - P.P.M. <br /> D 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 133 <br /> *NO PLACARDS OR MARKINGS REQUIRED* NEXT SERVICE DATE <br /> D OTHER DRUMS DRUM SIZE <br /> MANIFEST NO. NO.OF GALLONS <br /> DRIVER TRUCK NO.&RT ' e- <br /> ❑ NON HAZARDOUS DRAINED USED OIL FILTER <br /> ❑ COMMERCIAL FILTER RECYCLING,33210 Western Avenue, Union City, CA,510-487-9277 <br /> Ll ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ ALVISO INDEPENDENT OIL-5002 Archer Street•Alviso, GA 95502•CAL000161743.(510)476-1740 <br /> ❑ BAYSIDE OIL 11,INC.•210 Encinal Street•Santa Cruz, CA 95060.CADDS8838222•(831) 427-3773 <br /> ❑ EVERGREEN ENV, .4139 N Valentine Ave • Fresno, CA 93722 e CAD982446882 e (510) 795-4400 <br /> ❑ DEMENNO/KERDOON •2000 N.Alameda Street•Compton,CA 90222-CAT080013352• (310)537-7100 <br /> Q D!K DIXON•7300 Chevron Way.Dixon,CA 95620.CAT080012602 e(707)693-6008 <br /> D 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 /> EC OIL,USED ANTIFREEZE CO OILY WATER WASTE STREAMS ARE This fs to certifythat the above named articles are properly classified,described, packaged, marked <br /> @CYCLED AT OUR SISTER COMPANY D WESTERN UNITED ST THE and labeled, anare in proper condition for transportation,according to the applicable regu;ations of <br /> ARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Department of Transportation. <br /> HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> THER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 RPM.; X r <br /> VD THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTOMER SIGNATURE PATE <br /> FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br /> iSPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR <br /> DNTAINS ANY P.C.B'S. PRINT NAME <br />