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• FORM NO.AES003 <br /> SERVICE ORDER <br /> No. N 631896 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221 0 (310) 886-3400 <br /> SAN DIEGO OFFICE NORTHERN CALIFORNIA <br /> 1-800-748-5744 EPA CAD028277036 1-800-727-2879 <br /> DATE ONETIME PICK UP F-1 YES or ❑NO <br /> CUSTOMER RESIDENCE ❑ YES or 'E) NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or 11 NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE . CONTACT CUSTOMER NUMBER <br /> CUSTOMER EPA# AMOUNT <br /> JOB SITE ADDRESS ti :. CHECK NUMBER <br /> .. - <br /> y 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 OIUMIXED 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 /> Q 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 /> 0 BAYSIDE OIL 11,INC.•210 Encinal Street•Santa Cruz,CA 95060•CAD088838222-(408)427-3778 <br /> ❑ EVERGREEN ENV..4139 N.Valentine Ave. •Fresno, CA 93722*CAD982446882 a(510)795-4400 <br /> ❑,:•OEMENNO/KERDOON •2000 N.Alameda Street•Campton, CA 90222•CAT080013352•(310)537-7100 <br /> d DAC DMON.7300 Chevron Way•Dkon,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 /> 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 regulations of <br /> RGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES, the Department areTransportation.proper <br /> c <br /> 1 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 <br /> NO THATTHE WASTE DOES NOT CONTAIN ANY P.C.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. PRINT NAME <br />