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• a_ ( U `,� �. \ • FORM NO.AES003 <br /> SERVICE ORDER <br /> _- No. N 656702 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221 ❑ (310) 886-3400 <br /> DIXON UNION CITY <br /> 1-800-727-2879 EPACAD028277036 1A88-6038844 —• <br /> DATE 3o�a ONETIME PICK UP, DYES or ONO <br /> CUSTOMER _z RESIDENCE ` ❑ YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> p� SERVICE ORDER <br /> PHONE �l'C1 �1/_e �% CONTACT '�o CUSTOMER NUMBER �"` 0'/1 <br /> / <br /> � q 7 <br /> CUSTOMER EPA d ( 'n ll�.,000�� JI 2',,,/// �' AMOUNT <br /> JOB SITE ADDRESS l �CL.l.�2"l..�G / CHECK NUMBER <br /> r/ /��J�Cj–t,�• �VZ/45):12 P.O.NUMBER <br /> i <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY Z,= )) <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 /> - <br /> MANIFEST NO. N OF GALLONS <br /> DRIVER I IFILICK NO.&RT. '/7 <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: ❑ BAKERSFIELD TRANSFER INC.-1620 E.Brundage Ln.•Bakersfield,CA 93307•CAL000282598•(661)377-0308 <br /> ❑ 13AYSIDE OIL 11,INC.•210 Encinal Street•Santa Cruz,CA 95060•CAD088838222•(831)421-3773 <br /> ❑ EVERGREEN ENV.•4139 N. Valentine Ave. •Fresno, CA 93722•CA0982446882•(510)795-4400 <br /> DEMENNO/KERDOON •2000 N.Alameda Street•Compton,CA 90222•CAT080013352•(310)537-7100 <br /> �j DIK DIXON•7300 Chevron Way•Dixon,CA 95820•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 /> USED Olt.,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to certify that the above named articles are properly classified,described,packaged,}narked <br /> RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled,and are in propty condition for transportation,according to the applicable regulations of <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Department o nsporta n. <br /> •1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY Zc <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN t P.P.M.; X I�' —L <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.e'S.. cusroM R SIGNATURE GATE <br /> -1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br /> DISPOSAL IF THIS WASTE IS OVER 1000 PPM.TOTAL HALIDES. OR <br /> ,CONTAINS ANY ROSS. PRINT NAME <br /> L <br />