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FORM NO. AES003 <br />SERVICE ORDER <br />No. N 635307 <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 CA0028277036 14018-803-8844 <br />DATE <br />- <br />CUSTOMER <br />BILLING ADDRESS <br />o - a <br />PHONECONTACT <br />CUSTOMER EPA 1Y <br />JOB SITE ADDRESS x/? <br />?E5 <br />CROSS STREETS <br />NOTES: <br />I,lON-RCRA HAZARDOUS WASTE, LIQUID (USED OIL/MIXED OILS) STATE CODE 221 <br />JF 'NO PLACARDS REQUIRED* <br />ONE TIME PICK UP C YES or 0 NO <br />RESIDENCE ❑ YES or ❑ NO <br />CONTRACT CUSTOMER Ci 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 />(AMOUN17 <br />COMMODITY <br />HALIDES !C:;l1sQ 40 P.P.M. <br />F) NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE 133 <br />*NO PLACARDS OR MARKINGS REQUIRED* NEXT SERVICE DATE <br />C OTHER DRUMS DRUM SIZE T_ <br />MANIFEST NO. ��� Gy�s�!�_�Y..I, NO. OF GALLONS O C) <br />DRIVER ---� L TRUCK NO. B RT. � <br />C NON HAZARDOUS DRAINED USED OIL FILTER <br />U COMMERCIAL FILTER RECYCLING, 33210 Western Avenue, Union City, CA, 510-487-9277 <br />C ALTERNATE FACILITY <br />DESIGNATED TSDF: n ALVISO INDEPENDENT OIL - 5002 Archer Street - AMSO, CA 95502 • CALOODI61743 • (510) 478-1740 <br />C❑ EIAYSIDE OIL II, INC. • 210 Encinal Street • Santa Cruz, CA 95060 • CAD088838222 • (831) 427-3773 <br />G EVERGREEN ENV. • 4139 N Valentine Ave * Fresno, CA 93722 e CAD962446882 • (510) 795-4400 <br />1 DEMENNO/KERDOON - 2000 N. Alameda Street • Complon, CA 90222 • CAT080013352 • (310) 537-7100 <br />D1K DIXON • 7300 Chevron Way a Dixon, CA 95620 • CAT080012602 • (707) 693-6008 <br />C RAMOS ENVIRONMENTAL . 1515 S River Road . W. Sacramento, CA 95691 . CAD044003558 . (916) 371-5747 <br />• ASBURY ENVIRONMENTAL SERVICES • 2549 Scott Avenue • Chico, CA 95928 CAL000827044 <br />C ALTERNATE FACILITY <br />USED OIL, USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This * to cv bove nn imed des a property ciaseilled, deaaibed, packaged, marked <br />RECYCLED AT OUR SISTER COMPANY DEMENNOIKERDOON THE end lab an oyer -wri ti t orianon, according to the appGrable regulattons of <br />LARGEST RECYCLER OF USED OIL IN THE WESTERN UNRED STATES. the art of Tr t <br />'I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br />OTHER WASTE, THAT THE TOTAL HALIDES ARE LESS THAN 10M PPM, X I-h7l—la <br />AND THAT THE WASTE DOES NOT CONTAIN ANY PC.S'S.. CUSTOMER SIGNATURE DATE <br />'I FURTHER AGREE TO ACCEPT THE ADDiT10NAL CHARGES FOR LEGAL <br />DISPOSAL IF THIS WASTE IS OVER 1000 PP.M. TOTAL HALIDES, OR X PRINT NAME <br />CONTAINS ANY P.C.8'S. <br />