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FORM NO.AES003 <br /> SERVICE ORDER <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S. SANTA FE AVENUE a COMPTON,CALIFORNIA 90221 a (310) 886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPA CAD028277036 1-888-603-8844 <br /> DATE .�.�" �, -'`. <br /> -� _ ONETIME PICK UP ❑YES or ❑NO <br /> CUSTOMER `� /' • RESIDENCE <br /> BILLING <br /> or EI NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE..,�V�'�� C�'� <br /> _~ a ?i _ CONTACT V- r. CUSTOMER NUMBER <br /> CUSTOMER EPA# tib. c^"�i ,� " /% AMOUNT <br /> JOB SITE ADDRESS ? t f f CHECK NUMBER <br /> � r <br /> 7 <br /> e"— P.O.NUMBER <br /> Fr <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUN-0 <br /> NOTES: COMMODITY ;, G'' <br /> HALIDES r>-, .- P.P.M. <br /> Com:_ 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 /> ❑ OTHER DRUMS DRUM SIZE <br /> MANIFEST NO. NO.OF GALLONSQ.!" ' <br /> DRIVER TRUCK NO.&RT ' e-" <br /> ❑ NONHAZARDOUS DRAINED USED OIL FILTER <br /> E COMMERCIAL FILTER RECYCLING,33210 Western Avenue, Union City,CA,510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ ALVISO INDEPENDENT OIL-5002 Archer Street•Alviso,OA 95502 CAL000161743•(510)476-1740 <br /> ❑ BAYSIDE OIL 11,INC.•210 Encinal Street•Santa Cruz, CA 95060•CAD088838222•(831) 427.3773 <br /> ❑ EVERGREEN ENV. •4139 N.Valentine Ave • Fresno, CA 93722.CAb982446882 e (510) 795-4400 <br /> PC DEMENNO/KERDOON -2000 N.Alameda Street•Compton,CA 90222•CAT080013352• (310)537-7100 <br /> ❑ D/K DIXON.7300 Chevron Way a Dixon,CA 95620.CAT080012602.(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 /> ISED O1L,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE <br /> IECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE This is certify that the above named articles are properly classified,described, packaged, marked <br /> ARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES, and labelel re ed, and are in proper condition for transportation,according to the applicable regulations of <br /> the Department of Transportation. <br /> HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> THEIR WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; <br /> NO THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTOMER SIGNATURE DATE <br /> FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES jFflR LEGAL X <br /> ISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR <br /> ONTAINS ANY PC.B'S. PRINT NAME <br />