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FARM NO.AE5003 <br /> SERVICE ORDER <br /> NO. N 63"1 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE ❑ COMPTON.CALIFORNIA 90221 ❑ (310) 886-3400 <br /> SAN DIEGO OFFICE NORTHERN CAIJFORNIA <br /> 1-800-748-5744 EPA CAD022277036 1-800-727-2874 <br /> -_•F <br /> DATE ONETIME PICK UP LJ YES or ❑NO <br /> CUSTOMER ;- '` RESIDENCE ❑ YES or C] NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE CONTACT <br /> 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 PPM, <br /> El NON-RCRA HAZARDOUS WASTE, LIQUID(USED OH-/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. NO.OF GALLONS <br /> DRIVER 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•A1v1so, CA 95502•CAL000161743•(510)476-1740 <br /> ❑ BAYSIDE OIL II,INC.•210 Encinal Street•Santa Cruz,CA 95060•CAD068838222-(408)427-3778 <br /> ❑ EVERGREEN ENV. .4139 N. Vaientine Ave. • Fresno, CA 93722.CAD982446882 e (510)795-4400 <br /> ❑` DEMENNO/KERDOON •2000 N.Alameda Street•Compton,CA 90222•CAT080013352• (310)537-7100 <br /> ❑ DIK DIXON.7300 Chevron Way o Dixon,CA 95620 e CAT080012602 e(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 /> ECYCLEp AT OUR SISTER COMPANY p WESTERN UNITED ST THE and labeled,and are in proper condition for transportation,according to the applicable regulations of <br /> RGE$T REGYCLER 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.W; X <br /> ND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTOMER SIGNATURE HATE <br /> 1 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. POINT NAME <br />