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• • t • FORM NO.AES003 <br /> _ SERVICE ORDER <br /> No. N 636940 <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 I A88-6038844 <br /> DATE / � ONETIME PICK UP [I YES or ❑NO <br /> CUSTOMER RESIDENCE ❑ YES or ❑ NO <br /> - BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE.-5�R�,�--7•"GO'�Jv a CONTACT /')OG�J CUSTOMER NUMBER <br /> CUSTOMER EPA N ,��� nn AMOUNT <br /> JOB SITE ADDRESS ( yo '/CJl/7- /1` CHECK NUMBER <br /> PO,NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY <br /> HALIDES PPM, <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS)STATE CODE 221 <br /> •NO P.EACARDS REQUIRED- <br /> C�.�NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS)STATE CODE 133 <br /> ll��•NO PLACARDS OR MARKINGS REQUIRED- NEXT SCE DATE <br /> ❑ OTHER DRUMS/ DRUM SIZE <br /> SIZE <br /> MANIFEST NO. K5 Y30SNO.OF GALLONS /-.5 <br /> DRIVER TRUCK NO.&AT <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: ❑ ALVISO INDEPENDENT OIL-5002 Archer Street•Alviso,CA 95502•CAL000161743•(510)476-1740 <br /> ❑ BAYSIDE OIL II,INC.-210 Encinal Street-Santa Cruz,CA 95060,CAD088838222•(831)427.3773 <br /> ❑ EVERGREEN ENV.•4139 N.Valentine Ave •Fresno.CA 93722•CAD982446882•(510)795-4400 <br /> D MENNO/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 /> ❑ RAMOS ENVIRONMENTAL.1515 S.River Road .W.Sacramento,CA 95691.CAD044003556 .(916)371-5747 / <br /> O 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 c�[7' Mat the above nam aNdes are propeTlY hlessiAed, tlescrihed, packaged, marked <br /> RECYCLED AT OUR SISTER COMPANY DEM ENNO/KERDOON THE and lahektl,an are in proper cn ion for transpori?ti6n,according to the applicable regulations of <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the <br /> De rtment i Trensportah / ^/� / <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.. CU IGNATU oA?E <br /> •1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br /> DISPOSAL IF THIS WASTE IS OVER 1000 PRIA,TOTAL HALIDES, OR PRINT NAME <br /> CONTAINS ANY P.C.B'S. <br />