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FORM NO. AES003 <br />SERVICE ORDER <br />No. N 634998 <br />�- ASBURY ENVIRONMENTAL SERVICES <br />1300 S. SANTA FE AVENUE o COMPTON, CALIFORNIA 90221 o (310) 886-3400 <br />DIXON UNION CITY <br />1-800.727-2879 EPA CAD028277036 1-888-603-8844 <br />DATE <br />j 6. f..-).. G r <br />CUSTOMER <br />BILLING ADDRESS <br />PHONE ,'?O e� ;'19- t<,—e--..S— CONTACT <br />CUSTOMER EPA N `%a• l��"7G r .�sr _ <br />JOB SITE ADDRESS <br />^.,FIOSS STREETS <br />73- NON•RCRA HAZARDOUS WASTE, LIQUID (USED OIUMIXED OILS) STATE CODE 22,1 <br />'NO PLACARDS REQUIRED" <br />NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE 133 <br />*NO PLACARDS OR MARKINGS REQUIRED" <br />3 OTHER <br />MANIFEST NO. <br />DRIVER <br />3 NON HAZARDOUS DRAINED USED OIL FILTER <br />7 COMMERCIAL FILTER RECYCLING. 33210 Western Avenue, Union City, CA, 510.487-9277 <br />D ALTERNATE FACILITY <br />ONE TIME PICK UP <br />RESIDENCE <br />OYES or ❑ NO <br />Q YES or ❑ NO <br />CONTRACT CUSTOMER O YES or ❑ NO <br />PLEASE PAY FROM THIS <br />SERVICE ORDER <br />CUSTOMER NUMBER <br />AMOUNT <br />CHECK NUMBER <br />P.O, NUMBER <br />CASH RECEIVED <br />"0UNT1 <br />COMMODITY ' <br />`HALIDES i �, P.P.M. <br />NEXT SERVICE DATE <br />DRUMS DRUM SIZE <br />- <br />TRUCK NO. B HT _ St.. r - <br />DESIGNATED TSDF: LJ ALVISO INDEPENDENT OIL - 5002 Archer Street • Alviso, CA 95502 • CAL000161743 • (510) 476-1740 <br />❑ BAYSIDE OIL ll, INC. • 210 Encinal Street • Santa Cruz, CA 95060 • CA0088838222 • (831) 427.3773 <br />❑ EVERGREEN ENV. • 4139 N. Valentine Ave • Fresno, CA 93722 • CAD982446882 • (510) 795-4400 <br />C�„ DEMENNO/KERDOON • 2000 N. Alameda Street • Compton, CA 90222 • CATOB0013352 • (310) 537-7100 <br />❑ DIK DIXON . 7300 Chevron Way . Dixon, CA 95620 . CAT080012602 . (70T) 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 />rt, USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE <br />i" --[D AT OUR SISTER COMPANY OEfMENNOIKERDOON THE <br />.,TEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. <br />This is to certify Ihat the above named articles are property classifiers, described, packag d, marked <br />and labeled, and are in proper cmWition for transportation, according to the applicable regufalions of <br />the Doparimem of Transportation. <br />iEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY �ry <br />HER WASTE. THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; X <br />D THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. CUSTOMER SIGNATURE OATE <br />"URTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br />3POSAL IF THIS WASTE IS OVER 1000 P.P.M. TOTAL HALIDES, OR <br />PRINT NAME <br />