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FORM NO.AES003 <br /> SERVICE ORDER <br /> - �= - NO. N 610889 <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 EPACAD028277036 1-800-727-2879 <br /> DATE <br /> l - a' dNE TIME PICK UP <br /> El YES or El NO <br /> CUSTOMER � t"� RESIDENCE ❑ YES or ❑ NO <br /> M'' f �•' �' <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or EJ NO <br /> "� � �''�`�-� <br /> PLEASE PAY FROM THIS <br /> SERVICE ODER <br /> �. <br /> CUSTOMER NUMBER 1 <br /> PHONE <br /> CONTACT <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.R.M. <br /> ❑ NON-RCRA HAZARDOUS WASTE, LIQUID(USED OILIMIXED OILS)STATE CODE 221 <br /> *NO PLACARDS REQUIRED* <br /> E) NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE 133 \ <br /> *NO PLACARDS OR MARKINGS REQUIRED* NEXTRVICE DATE <br /> ❑ OTHER - DRUMS7 DRUM SIZE <br /> MANIFEST NO. <br /> - <br /> NO.OF GALLONS <br /> DRIVER TRUCK NO.&RT <br /> C\NON HAZARDOUS DRAINED USED OIL FILTER <br /> `,,COMMERCIAL FILTER RECYCLING,33210 Western Avenue,Union City,CA,510-487-9277 <br /> ❑ ALTERNATE FACILITY.- <br /> DESIGNATED <br /> ACILITYDESIGNATED TSDF: ❑ ALVISO INDEPENDENT OIL-5002 Archer Street•Alviso,CA 95502•CAL000161743-(510)476-1740 <br /> ❑ BAYSIDE OIL 11,INC,•210 Encinal Street•Santa Cruz,CA 95060•CA0088838222•(408)427-3778 <br /> Q EVERGREEN ENV.•4139 N.Valentine Ave. • Fresno, CA 93722•CAD982446882•(510)795-4400 <br /> p DEMENNO/KERDOON •2000 N.Alameda Street•Compton,CA 90222-CAT080013352•(310)537-7100 <br /> ❑ DIK DIXON•7300 Chevron Way•Dixon,CA 95620*CAT080012602•(707)693-6008 <br /> ❑ RADIOS 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, marl <br /> RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled, and are in proper condition for transportation,according to the applicable regulation: <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Department,o#-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 PPM.; 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 1000 P.P.M.TOTAL HALIDES, OR PRINT NAME <br /> CONTAINS ANY P.C.B'S. <br />