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FORM NO.AES003 <br /> SERVICE ORDER <br /> _ = NO. N 634864 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S. SANTA FE AVENUE Q COMPTON, CALIFORNIA 90221 ❑ (31 O} 886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPA CAD028277036 1-888-603-8844 <br /> DATE ' ONETIME PICK UP DYES or ❑NO <br /> CUSTOMER'' ' -`"l i? k- ` ' RESIDENCE ❑ YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> df, SERVICE ORDER <br /> PHONE '"` C Pr N' CONTACT $ x� CUSTOMER NUMBER <br /> 7 <br /> CUSTOMER EPA# r .- r~ t 4. ;r N;� AMOUNT <br /> JOB SITE ADDRESS FC.-- r_ ` - '3 =- � CHECK NUMBER <br /> �Y <br /> P.O.NUMBER <br /> , <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY .>�x,7'F'r„ <br /> HALIDES '<"" PP.M. <br /> �T 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. -�` + , 'r j jse:f NO.OF GALLONS <br /> DRIVER #f�F .. 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 TSDF: ❑ 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*CA0982446882•(510)795-4400 <br /> Pte—EMENNO/KERDOON •2000 N.Alameda Street•Compton,CA 90222•CAT080013352•(310)537-7100 <br /> `C] DIK 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 /> Ll ALTERNATE FACILITY <br /> SED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to certify that the above named articles are properly classified, described, packaged, marked <br /> ECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled,and are in proper condition for transportation, according to the applicable Teguiafions of <br /> RGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. 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 LESS THAN 1000 PP-M-; X 1 l// t r <br /> NO THAT THE WASTE DOES NOT CONTAIN ANY PC.B'S.. CUSTOMER SIGNATURE DATE <br /> I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL <br /> ISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR <br /> ONTAINS ANY P.C.B'S. PRINTNAME <br />