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FORM NO.AES003 <br /> SERVICE ORDER <br /> No. N 635068 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S. SANTA FE AVENUE 0 COMPTON, CALIFORNIA 90221 ❑ (310) 886-3400 <br /> DIXON UNION CITY <br /> 1,800-727-2879 EPA CAD028277036 1$88-60343844 <br /> DATE ONETIME PICK UP DYES or ❑NO <br /> CUSTOMER .'`.. �"" c . s k.�,� <br /> RESIDENCE ❑ YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE ` { +" ;= CONTACT % '' CUSTOMER NUMBER <br /> CUSTOMER EPA# /`Gi; s �.. "r <br /> — � � ��� -�,: -_yf AMOUNT <br /> JOB SITE ADDRESS t✓ V tf : e^ c CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: <br /> COMMODITY ': <br /> HALIDES P.P.M. <br /> 2'-NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIL/MIXED OILS)STATE CODE 221 <br /> *NO PLACARDS REQUIRED* <br /> C 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. ! ."' � ~ ) `. <br /> NO,OF GALLONS <br /> DRIVER �'' itrs�f- <br /> - TRUCK NO.&RT <br /> ❑ NON HAZARDOUS DRAINED USED OIL FILTER <br /> ❑ COMMERCIAL FILTER RECYCLING,33210 Western Avenue,Union City,CA,510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSD F: ❑ ALVISO INDEPENDENT OIL-5002 Archer Street•Alviso, 0A 95502•CAL000161743•(510)476-1740 <br /> ❑ BAYSIDE OIL II,INC.•210 Encinal Street•Santa Cruz, CA 95060•CAD068838222•(831) 427-3773 <br /> ❑ EVERGREEN ENV. .4139 N. Valentine Ave. . Fresno, CA 93722 e CAD982446882.(510)795-4400 <br /> Ca' 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 e(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL.1515 S.River Road .W.Sacramento,CA 95691 .CAD044003556 .(916)371-5747 <br /> Cl ASBURY ENVIRONMENTAL SERVICES•2549 Scott Avenue•Chico,CA 95928•CAL000827844 <br /> ❑ ALTERNATE FACILITY <br /> SED OIL,USED ANTIFREEZE CO OILY WATER WASTE STREAMS ARE T {t�certify that the above named articles are properly classified,described, packaged, marked <br /> RGEST R C OUR SISTER COMPANY D WESTERN <br /> UNITED ST THE a (ed and are in proper condition for transportation, according to the applicable regulations of <br /> ARGEST RECYGLER OF USED 01L IN THE WESTERN IiNITECI STATES. the prtment 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 P,PM.; X I t <br /> NDTHATTHE WASTE DOES NOTCONTAIN ANY PC.B'S.. CUSTOMER SIGNATURE DATE <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 />