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.'FORM NO. AES003 <br />SERVICE ORDS"-. <br />ASBURY ENVIRONMENTAL SERVICES <br />1300 S. SANTA FE AVENUE ❑ COMPTON, CALIFORNIA 90221 ❑ )310) 886-3400 <br />EPA# CAD028277036 <br />DIXON UNION CITY - CHICO <br />800-727-2879 888-603-8844 800-733-9043 <br />DATE <br />CUSTOMER <br />t <br />_�,L-✓'n'' f ' <br />S '- rr' ; '` <br />/ ✓ <br />BILLING ADDRESS <br />PHONE <br />r `• '" -T <<,,. <br />CONTACT <br />CUSTOMER EPA # <br />`` 3 •f i, t" -,G7 <br />'F+ 'ir"'"- L. <br />JOB SITE ADDRESS <br />C <br />CROSS STREETS <br />NOTES: <br />ONE TIME PICK UP OYES or ONO <br />RESIDENCE ❑ YES or ❑ NO <br />CONTRACT CUSTOMER ❑ YES or D NO <br />PLEASE PAY FROM THIS r <br />SERVICE ORDER <br />CUSTOMER NUMBER , <br />AMOUNT <br />! CHECK NUMBER <br />P.O. NUMBER <br />CASH RECEIVED <br />(AMOUNT) <br />COMMODITY <br />HALIDES P.P.M. <br />I'] NON-RCRA HAZARDOUS WASTE,. LIQUID (USED OIL/MIXED OILS) STATE CODE z4l <br />*NO PLACARDS REQUIRED* <br />❑ NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS). STATE CODE <br />*NO PLACARDS OR MARKINGS REQUIRED* - NEXT SERVICE DATE <br />❑OTHER— <br />MANIFEST <br />THER_MANIFEST NO. _ <br />DRIVER <br />❑ USED OIL AND GASOLINE FILTERS <br />❑ SARECYCLING, 33210 Western Avenue, Union City, CA 94587 1-510-487-9277 <br />❑ ALTERNATE FACILITY <br />DRUMS DRUM SIZE <br />NO. OF GALLONS <br />TRUCK NO. & RT <br />DESIGNATED TSDF: ❑ ASBURY ENVIRONMENTAL SERVICES .• 2549 Scot Avenue • Chico, CA 95928 • CAL000827844 <br />❑ ASBURY ENVIRONMENTAL SERVICES-CHICO II, LLC • 1618 W. 5th St., Chico, CA 95928 • CAD980694103 • (800) 733-9043 <br />❑ ASBURY ENVIRONMENTAL SERVICES-FORTUNA • 200 Dinsmore Dr., Fortuna, CA 95540 • CAL93C256136 • (800) 733-9043 <br />❑ BAKERSFIELD TRANSFER INC. • 1620 E. Brundage Ln. •Bakersfield, CA 93307 • CAL000282598 • (661) 377-0308 <br />❑ D/K DIXON • 7300 Chevron Way • Dixon, CA 95620 • CAT080012602 • (707) 693-6008 <br />E7 DEMENNO/KERDOON • 2000 N. Alameda Street •Compton, CA 90222.• CAT080013352 • (310) 537-7100 <br />D EVERGREEN ENV. • 4139 N. Valentine Ave. • Fresno, CA 93722 • CAD982446882 • (510) 795-4400 <br />❑ RAMOS ENVIRONMENTAL • 1515 S. River Road• W. Sacramento, CA 95691 • CAD044003556 •.(916) 371-5747 <br />❑ SAN JOAQUIN FILTER RECYCLING • 14287 E. Manning Ave. •. Parker, CA 93648 • CAL0001.02751. • (559) 498-0240 . <br />❑ ALTERNATE FACILITY <br />USED OIL, USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to certify that the above named articles are properly classified, described, packaged, market <br />RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled, and are in proper condition for transportation, according to the applicable regulations o' <br />LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Department of Transportation. <br />*1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY - / ; / / •�/ /, <br />OTHER WASTE, THAT THE TOTAL HALIDES. ARE LESS THAN 1000 PRM.; X <br />AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S,. CUSTOMER SIGNATURE DATE <br />*1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGAL- - <br />DISPOSAL IF THIS WASTE IS OVER 1000 RPM. TOTAL HALIDES. OR X +. <br />CONTAINS ANY P.O.B'S. PRINT NAME <br />