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FORM NO.AES003 <br /> SERVICE ORDER <br /> - = NO. N <br /> ASBURY ENVIRONMENTAL, SERVICES <br /> 1300 S. SANTA FE AVENUE o COMPTON,CALIFORNIA 90221 c (310) 886-3400 <br /> SAN DIEGO OFFICE NORTHERN CALIFORNIA <br /> 1-800-748-5744 EPA CAD028277036 1-800-727-2874 <br /> DATE ONETIME PICK UP ❑YES or LINO <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# s 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 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. _ 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: Q 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-a 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 /> ❑ D/K DIXON a 7300 Chevron Way.D'ocon,CA 95620.CAT060012602 a(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL.1515 S.River Road .W.Sacramento,CA 95691 .CA0044003556 .(916)371-5747 <br /> 1l 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 AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled, and are in proper condition for transportation, according to the appSicable regulations of <br /> LARGEST RECYCLES 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 1008 P.P.M.; X ' <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S., CUSTOMER SIGNATURE DATE <br /> *1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br /> DISPOSAL IF THIS WASTE IS OVER 100D P.RM,TOTAL HALIDES, OR <br /> CONTAINS ANY P.C.B'S. PRINT NAME <br />