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FORM NO.AES003 <br /> SERVICE ORDER <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE El COMPTON, CALIFORNIA 90221 ❑ (310) 886-3400 <br /> DIXON <br /> UNION CITY <br /> 1-800-727-2879 EPA CAD028277036 1-888-603-8844 <br /> DATE ONETIME PICK UP DYES or ❑NO <br /> CUSTOMER !1''�" '- RESIDENCE p YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE r� e.���" ,f 'r.s ' -. <br /> CONTACT CUSTOMER NUMBER <br /> CUSTOMER EPA# AMOUNT <br /> �F f <br /> JOB SITE ADDRESS - ' €.. CHECK NUMBER <br /> f P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY <br /> HALIDES P.P.M. <br /> 0, NON-RCRA HAZARDOUS WASTE, LIQUID(USED OIUMIXED OILS)STATE CODE 221 <br /> *NO PLACARDS REQUIRED* <br /> D 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.&FIT. <br /> D NON HAZARDOUS DRAINED USED OIL FILTER <br /> ❑ COMMERCIAL FILTER RECYCLING,33210 Western Avenue,Union City,CA,510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: D ALVISO INDEPENDENT OIL-5002 Archer Street•Alviso,CA 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 e CAD982446882 e (510)795-4400 <br /> 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 /> ❑ ASBURY ENVIRONMENTAL SERVICES-X549 Scott Avenue•Chico, CA 95928•CAL000827844 <br /> ❑ ALTERNATE FACILITY <br /> SED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This i,to certify that the above named articles are properly classified, described, packaged. marked <br /> ECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE P 9 <br /> RGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. and.Jabeled,-and are in proper condition for transportation, according to the applicable regulations of <br /> the 06partment 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.P.M.; X P I I <br /> NO THAT THE WASTE DOES NOT CONTAIN ANY PC.B'S.. CUSTOMER SIGNATURE FATE <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 /> ONTAINS ANY P.C.B'S. PRINT NAME <br />