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DATE <br />CUSTOMER <br />BILLING ADDRESS <br />FORM NO. AES003 <br />SERVICE ORDER <br />_ NO. N 6.34939 <br />ASBURY ENVIRONMENTAL SERVICES <br />1300 S. SANTA FE AVENUE 0 COMPTON, CALIFORNIA 90221 0 (310) 886-3400 <br />DIXON UNION CITY <br />14K)O-727-2579 EPA CAD028277036 1^888403-86't4 <br />;7./1; F ONETIMEPICK UP DYES or ❑ NO <br />PHONE ,' � � � C � CONTACT e, �43 <br />CUSTOMEREPA <br />JOB SITE ADDRESS •�' - 3��A' rF <br />CROSS STREET$ <br />f" <br />RESIDENCE 0 YES or 0 NO <br />CONTRACT CUSTOMER ❑ 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 />tAMotmrT) <br />COMMODITY 4 i <br />`HALIDES <'O c 'r e_r P.P.M. <br />M'_'NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIL/MIXED OILS) STATE CODE 221 <br />*NO ,PLACARDS REQUIRED* <br />0 NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE133 NEXT SERVICE DATE <br />•NO PLACARDS OR MARKINGS REQUIRED* <br />0 OTHER <br />MANIFEST NO.— <br />DRIVER <br />❑ NON. HAZARDOUS DRAINED USED OIL FILTER <br />❑ COMMERCIAL FILTER RECYCLING, 33210 Western Avenue, Union City, CA, 510-487-9277 <br />❑ ALTERNATE FACILITY <br />DRUMS DRUM SIZE <br />NO:OF-GALLONS <br />1RUCK NO. $ HT. �x <br />DESIGNATED TSDF: D ALVISO INDEPENDENT OIL- 50D2 Amer Street - Alviso, CA 95502 • CAL000161743 • (510) 476-1740 <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 />Q,QEMENNO/KERDOON • 2000 N. Alameda Street - Compton. CA 90222 - CAT080013352 • (310) 537-7100 <br />❑ DIX DIXON* 7300 Chevron Way • Dbton, CA 95620 • CAT080012602 • (707) 693.6406 <br />❑ RAMOS ENVIRONMENTAL .1515 S. River Road . W_ Sacramento, CA 95691. CA0044003556 . (916) 371-5747 <br />❑ ASBURY ENVIRONMENTAL SERVICES • 2549 Scott Avenue - Chico, CA 95928 - CAL000827844 <br />❑ ALTERNATE FACILITY <br />tp:wt )) USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to certify that the above named articles are properly classified, desailled, packaged, marked <br />r �ra.ED AT OUR SISTER COMPANY DEMENNOIKERDOON THE and Labeled. and are improper condylion for transportation, according to applicable regulations of <br />L ,EST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Depo"Ment of Tra0por <br />11 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br />OTHER WASTE, THAT THE TOTAL HALIDES ARE LESS THAN 1000 PP.M.; Xr- <br />AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. �WSTOMER SIGNATURE DrrTE <br />*I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL <br />