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FORM NO.AES003 <br /> SERVICE ORDER <br /> - - - NO,. N 634969 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FF AVENUE ❑ COMPTON, CALIFORNIA 90221 ❑ (310) 886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPA CAD028277036 1-688-603-8844 <br /> DATE ONETIME PICK UP ❑YES or []NO <br /> CUSTOMER ; .��_ J, 3r `J <br /> RESIDENCE <br /> El YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE ` ' CONTACT i=cy g <br /> CUSTOMER NUMBER <br /> r"7 . # <br /> CUSTOMER EPA# e— ,r ,e'r'`„r'"i''_. <br /> AMOUNT <br /> JOB SITE ADDRESS ,. F" rt , /r`<- f- <br /> CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> r (AMOUNT) <br /> NOTES: COMMODITY <br /> HALIDES 't _; P.P.M. <br /> b',•'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 GALLONS <br /> DRIVER .. . 'TRUCK NO.&RT <br /> ❑ NON HAZARDOUS DRAINED USED OILFILTER <br /> ❑ COMMERCIAL FILTER RECYCLING,33210 Western Avenue, Union City,CA,510-467-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ ALVISO INDEPENDENT OIL-5002 Archer Street•Alviso, CA 95502•CAL000161743-(510)476-1740 <br /> BAYSIDE OIL II,INC.•210 Encinal Street•Santa Cruz, CA 95060•CAD088838222•(831) 427-3773 <br /> ❑ EVERGREEN ENV. •4139 N. Valentine Ave. • Fresno, CA 93722 e CA0982446882•(510)795-4400 <br /> j-1`7"DEMENNO/KERDOON •2000 N.Alameda Street•Campton,CA 90222•CAT080013352•(310) 537-7100 <br /> ❑ 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 /> JSED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE <br /> RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE This is to certify that the above named articles are properly classified, described, packaged, marked <br /> ARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. and labeled,and are in proper condition for transportation, according to the applicable regulations of <br /> the Department of Transportation, <br />'I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY " <br />)THER WASTE,THAT THE TOTAL HALIDES ARE DESS THAN 1000 P.P.M.; X I '�✓` l <br /> 1NO THAT THE WASTE DOES NOT CONTAIN ANY PC.B'S.. <br /> CUSTOMER SIGNATURE DATE <br /> I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL <br />)ISPOSAL IF THIS WASTE IS OVER 1000 PP.M.TOTAL HALIDES, OR <br />.ONTAINS ANY P.C.B'S. PRINT NAME <br />