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• • FORM NO.AES003 <br /> SERVICE ORDER <br /> No. N 656372 <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 EPA CAD028277036 1-888-603-8844 <br /> DATE l/a �;, / ONE TIME PICK UP DYES or ONO <br /> CUSTOMER ef� RESIDENCE ❑ YES or ❑ NO <br /> BILLING ADDRESS ,, / CONTRACT CUSTOMER ❑ YES or O NO <br /> PLEASE PAY FROM THIS <br /> 1—' SERVICE ORDS <br /> PHONE,2Z2 ���T� O <br /> CONTACT V J O 74 CUSTOMER NUMBER <br /> CUSTOMER EPA N Cr9LOe7p Z j Z 9 3 3 AMOUNT <br /> JOB SITE ADDRESS 3 yn o CHECK NUMBER <br /> �— ,.r-/ '� n'-Y Co P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> � / (AMOUNT) <br /> NOTES: COMMODITY Lz/O <br /> HALIDE icy 0 ll 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. In S l�L-I -S kms_ NO.OF GALLONS <br /> DRIVER e A TRUCK NO.&RT. O <br /> O NONHAZARDOUS DRAINED USED OIL FILTIfR <br /> ❑ COMMERCIAL FILTER RECYCLING,33210 Western Avenue,Union Cay,CA,510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ BAKERSFIELD TRANSFER INC.-1620 E.Brundage Ln.•Bakersfield,CA 93307•CALD00282598•(661)377-0308 <br /> ❑ SAYSIDE OIL II,INC.•210 Encinal Street-Santa Cruz,CA 95060•CADOWS38222-(831)427-3773 <br /> ❑ EVERGREEN ENV..4139 N. Valentine Ave .Fresno, CA 93722•CAD982446882•(510)795-4400 <br /> >'VEMENNO/KERDOON •2000 N.Alameda Street•Compton, CA 90222•CAT080013352•(310)537.7100 <br /> /❑ DIK DIXON•7300 Chevron Way•Dixon,CA 95620•CATO80012602•(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL.1515 S.River Road .W.Sacramento,CA 95891.CAD044003556 .(916)371.5747 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES•2549 Scott Avenue•Chico,CA 95928-CALD00827844 <br /> ❑ ALTERNATE FACILITY <br /> USED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This Is to certify that a above namedarticles are properly classified,described, packaged, ed <br /> RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled,and ar n proper coedNbn for transportation,according to the applicable re a0ons of <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Department of T sponaam. <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 PC.B'S.. CU37 ION DATE <br /> 'I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br /> DISPOSAL IF THIS WASTE IS OVER 1000 PPM,TOTAL HALIDES, OR PRINT NAME <br /> CONTAINS ANY P.C.B'S. <br />