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FORM NO. AES003 <br />SERVICE ORDER <br />No. N 634936 <br />_ ASBURY ENVIRONMENTAL SERVICES <br />1300 S. SANTA FE AVENUE n COMPTON, CALIFORNIA 90221 zi (310) 886-3400 <br />DIXON UNION CITY <br />1-800.727-2879 EPA CAD028277036 1-888-603-8844 <br />DATE <br />,% /7f; f, <br />CUSTOMER �_� / ; �T _f/ 46! s <br />BILLING ADDRESS <br />PHONE t > �J` i ! r CONTACT <br />CUSTOMER EPA q <br />JOB SITE ADDRESS <br />CROSS STREETS <br />❑ NON.RCRA HAZARDOUS WASTE, LIQUID (USED OILIMIXED OILS) STATE CODE 221... <br />"NO PLACARDS REOUIRED• <br />❑ NON-RCRA HAZARDOUS WASTE. LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE _ 133 <br />`NO PLACARDS OR MARKINGS REQUIRED' <br />❑ OTHER <br />MANIFEST NO. <br />DRIVER <br />C NON HAZARDOUS DRAINED USED OIL FILTER <br />C COMMERCIAL FILTER RECYCLING, 332101Arestern Avenue, Union City, CA, 510-487-9277 <br />❑ ALTERNATE FACILITY <br />ONE TIME PICK UP ❑YES or FI NO <br />RESIDENCE El YES or ❑ 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 />(AMOUNT) <br />F <br />COMMODITY <br />HALIDES < '- c- '- f P.P.M. <br />NEXT SERVICE DATE <br />DRUMS DRUM SIZE <br />NO. OF GALLONS <br />1RUCK NO- & HT,_,� c > <br />DESIGNATED TSDF; E2 <br />ALVISO INDEPENDENT OIL - 5002 Arcner Streel • AIVISo, CA 95502 • CAL000181743 • (510) 476-1740 <br />BAYSIDE OIL II, INC. • 210 Encinal Street • Santa Cruz, CA 95060 • CA0088838222 • (831) 427-3773 <br />Li <br />EVERGREEN ENV.. 4139 N Valentine Ave • Fresno, CA 93722 • CAD982446882 • (510) 795.4400 <br />:---- DEMENNO/KERDOON - 2000 N. Alameda Street • Campton, CA 90222 • CAT080013352 • (310) 537-7100 <br />❑ <br />D/K DIXON • 7300 Chevron Way. Dixon, CA 95620 • CAT080012602 • (707) 693-6008 <br />❑ <br />RAMOS ENVIRONMENTAL . 1515 S. River Road . W. Sacramento, CA 95691 . CA0044003556 .(918) 371-5747 <br />F1 <br />ASBURY ENVIRONMENTAL SERVICES • 2549 Scon Avenue • Chico, CA 95928 • CAL000827844 <br />U ALTERNATE FACILITY <br />Ucr L, USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE <br />/-ED AT OUR SISTER COMPANY DEMENNOIKERDOON THE <br />L. EST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. <br />•1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br />OTHEn WASTE, THAT THE TOTAL HALIDES ARE LESS THAN 1000 RPM - <br />AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. <br />11 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL <br />DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M TOTAL HALIDES, OR <br />CONTAINS ANY P.C.B'S. <br />This is to certify that the above named articles aro properly classilied, described, packaged, marked <br />and Labeled, and are In: proper condition for transportation, according to the applicable regulalions of <br />the Deportment of Trantporiatso�' <br />V8 OMER SIGNATURE /V FATE / <br />PRINT NAMEf <br />