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FORM NO.AES003 <br /> SERVICE ORDER <br /> NO. N 6 i 4 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE a COMPTON,CALIFORNIA 90221 ri (310) 886-3400 <br /> SAN DIEGO OFFICE NORTHERN CALIFORNIA <br /> 1-800-748-5744 EPA CAD0282;7036 1-800-727-2879 <br /> DATE <br /> ONE TIME PICK UP F3 YES or D NO <br /> CUSTOMER 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# <br /> AMOUNT <br /> JOB SITE ADDRESS CHECK NUMBER <br /> P.O.NUMBER <br /> r <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY <br /> HALIDES RPM, <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED 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.&RT. <br /> ❑ NONHAZARDOUS DRAINED USED OIL FILTER <br /> ❑ COMMERCIAL FILTER RECYCLING,33210 Western Avenue, Union City,CA,510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF; Q 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•(408)427-3778 <br /> ❑ EVERGREEN ENV..4139 N.Valentine Ave..Fresno, CA 93722.CAD982446882.(510)795-4400 <br /> 11'LIEMENNO/KERDOON •2000 N.Alameda Street•Compton,CA 90222•CAT080013352•(310)537-7100 <br /> ❑ DIK DIXON a 7300 Chevron Way.Dixon,CA 95620.CAT080012602.(707)693-6006 <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 /> 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 UNITED ST THE and labeled,and are in proper condition for transportation,according to the applicable regulations of <br /> ARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Department of Transportation. g <br />°i HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br />)THER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 RPM.; X I ' <br /> kND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTOMER SIGNATURE <br /> 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. PRINT NAME <br />