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FORM NO.AES003 <br /> SERVICE ORDER <br /> NO. N 610888 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE © COMPTON,CALIFORNIA 90221 ❑ (310) 886-3400 <br /> SAN DIEGO OFFICE NORTHERN CALIFORNIA <br /> 1-800-748-5744 EPA CAD028277036 1-800-727-2879 <br /> DATE r �', <br /> ONE TIME PICK UP El YES or LINO <br /> CUSTOMER RESIDENCE ❑ YES or ❑ NO <br /> BILLING ADDRESS 'J`' CONTRACT CUSTOMER Il YES or ❑ NO <br /> ✓f PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE CONTACT CUSTOMER NUMBER <br /> CUSTOMER EPA# AMOUNT <br /> JOB SITE ADDRESS CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY <br /> HALIDES P.P.M. <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(USED OILJMIXED 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 OIL FILTER <br /> 0 .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 95,502•CAL000161743•(510)476-1740 <br /> ❑ BAYSIDE OIL 11,INC.•210 Encinal Street*Santa Cruz,CA 95060-CAD088638222•(408)427-3778 <br /> ❑ EVERGREEN ENV, *4139 N. Valentine Ave. *Fresno, CA 93722*CAD982446882* (510)795-4400 <br /> ❑ DEMENNO/KERDOON •2000 N.Alameda Street•Compton,CA 90222•CAT080013352*(310)537-7100 <br /> ❑ DIK DIXON*7300 Chevron Way*Dixon,CA 95620*CAT080012602*(707)693-6006 <br /> 17 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 /> USED 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 /> RECYCLED C OUR SISTER COMPANY D WESTERN�KERDOON THE acrd labeled,and are in proper condition for transportation,according to the applicable regulations of <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Department of Transportation. <br />*1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 RRM.; X <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY RC.B'S.. CUSTOMER SIGNATURE DATE <br />*1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br /> DISPOSAL IF THIS WASTE 1S OVER 1000 P.P.M.TOTAL HALIDES, OR <br /> CONTAINS ANY PC.B'S. PRINTNAME <br />