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• • FORM NO.AES003 <br /> SERVICE ORDER <br /> NO CHAR-J IL. <br /> No. N 656505 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221 ❑ (310)886-3400 <br /> DIXON UNION CITY <br /> 1-80D-727-2879 EPA CAD028277036 14886.603-8844 <br /> DATE �G T S ONETIME PICK UP ❑YES or ❑NO <br /> CUSTOMER /��{?�x�/�/ii�w a� . RESIDENCE ❑ YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE OR� <br /> '�]],� �� <br /> PHONE 9�'.G' �3�/CJ CONTACT �� CUSTOMER NUMBER <br /> CUSTOMER EPA p C/1ir oCf�/Z-5I_Z-2 <br /> z 9 AMOUNT - .1 <br /> JOB SITE ADDRESS 3�i rG /(�P(–�- �� CHECK NUMBER <br /> J7 tc,. P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY -f'l– n— <br /> HALIDES P.P.M. <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(USED OILIMIXED 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.Y7 �J/�- NO.OFF GALLONS <br /> DRIVER wv/ TRUCK NO.&RT 57:�:: <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 /> ❑ BAYSIDE OIL 11,INC.•210 Encinal Street-Santa Cruz,CA 95060-CAD088838222-(8311427-3773 <br /> ❑ EVERGREEN ENV. •4139 N.Valentine Ave. •Fresno, CA 93722•CA0982446882•(510)795-4400 <br /> 6�'–DEMENNO/KERDOON •2000 N.Alameda Street•Compton,CA 90222-CAT080013352•(310)537-7100 <br /> ❑ DJK DIXON•7300 Chevron Way•Dbton,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 /> 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 DEMENNOfKERDOON THE and labeled,and are in proper condition for transportation, according to the applicable regulations of <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Department of Trans tat' ��1,/� <br /> .1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY dlyj/-rrJ� yu <br /> OTHEFT WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 PPM.; X I1Q�e I <br /> AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. SUSrOMER 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 <br /> CONTAINS ANY PC.S'S. PRINT NAME <br />