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DATE <br />FORM NO, Af S003 <br />SERVICE ORDER <br />No. N 635367 <br />ASBURY ENVIRONMENTAL SERVICES <br />1300 S. SANTA FE AVENUE Li COMPTON. CALIFORNIA 90221 r 131 D) 886-3400 <br />DIXON UNION CITY <br />1-800-727-2879 EPA. CADOZ8277036 1-888-603-6844 <br />/ 'f. / r - , <br />CUSTOMER ! ri f✓ ='� <br />BILLING ADDRESS <br />PHONE 7 • <` (_ o - CONTACT <br />ONE TIME PICK UP DYES or ONO <br />RESIDENCE ❑ YES or LJ NO <br />CONTRACT CUSTOMER ❑ YES or ❑ NO <br />PLEASE PAY FROM THIS <br />r SERVICE ORDER <br />CUSTOMER NUMBER <br />CUSTOMER EPA #i _ ., 1 / l C fie, 7 ' r i' 7— <br />JOB <br />JOB SITE ADDRESS <br />c , <br />��--�� • '! r r . / �' sem-; , �.-� <br />CROSS STREETS <br />NOTES <br />AMOUNT <br />CHECK NUMBER <br />P.O. NUMBER <br />CASH RECEIVED <br />(AMOUNT) <br />COMMODITY <br />HAUDES C ' Gl3 G P.P.M. <br />O.NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIIJMIXED 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 REQUIRFD* NEXT SERVICE DATE <br />LJ OTHER t DRUMS DRUM SIZE <br />MANIFEST NO. %! No. OF flAi10NS <br />DRIVER TRUCK N0. & RT. C <br />❑ NON HAZARDOUS DRAINED USED OIL FILTER <br />❑ COMMERCIAL FILTER RECYCUNG, 33210 Western Avenue, Union City, CA, 510-487.9277 <br />❑ ALTERNATE FACILITY <br />DESIGNATED TSDF: ❑ ALVISO INDEPENDENT OIL - 5002 Archer Street - Mviso, CA 95502 - CAL000161743 • (510) 476-1740 <br />O BAYSIDE OIL II, INC. - 210 Encinal Streot -Santa Cruz, CA 95060 - CAD088830222 - (831) 427.3773 <br />❑ EVERGREEN ENV. - 4139 N Valentine Ave • Fresno, CA 93722 . CAD982446882 • (510) 795-4400 <br />Niv DEMENNO/KERDOON - 2000 N, Alameda Street • Compton. CA 90222 - CATOBOO13352 • (310) 537-7100 <br />DA( DIXON • 7300 Chevron Way • Dixon, CA 95620 . CAT080012602 s (707) 693-6008 <br />❑ RAMOS ENVIRONMENTAL .1515 S. River Road . W, Sacramento, CA 95691 . CA00440OM56 .(916) 371-5747 <br />❑ ASBURY ENVIRONMENTAL SERVICES - 2549 Scott Avenue - Chico, CA 95928 - CAL000827844 <br />D ALTERNATE FACILITY <br />USED OIL, USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This Is to ce Thal If1e above Hamad rficles ate erl dasstfied, descritlPd, <br />RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE p prop y packaged, marked <br />LARGEST REGYCLER OF USED OIL IN THE WESTERN UNITED STATES. and labeled, aN4re in proper C mditia?i )cz irbAsporfalm, according to the applieebla re,.11atlors of <br />the Department of Transportatwn, <br />11 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br />OTHER WASTE, THAT THE TOTAL HALIDES ARE LESS THAN 1000 PPM., X _ 1 C <br />AND THAT THE WASTE DOES NOT CONTAIN ANY P,C.B'S.. a CUSIUMtH SIGNATURE t11TE <br />'I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL X <br />DISPOSAL IF THIS WASTE IS OVER 1000 P.P,M. TOTAL HALIDES, OR <br />CONTAINS ANY P,C.B'S. PRINT NAME <br />