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Iy ASBURY ENVIRONMENTAL SERVICES Nom' N gQ� Ba <br /> 1300 S. SANTA FE AVENUE o COMPTON, CALIFORNIA 90221 ❑ (310) 886-3400 <br /> EPA#CAD028277036 <br /> DIXON UNION CITY CHICO FRESNO <br /> 800-727-2879 888-603-8844 800-733-9043 866-994-6937 <br /> DATE ONE TIME PICKUP DYES or ❑NO <br /> CUSTOMER ► +.t�G �"� RESIDENCE ❑ YES or ❑ N( <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑YES or ❑ N <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> 'HONE j y �' j CONTACT CUSTOMER NUMBER C <br /> ;USTOMER EPA# < ,- 1,---� 1 ( AMOUNT <br /> OB SITE ADDRESS `-1 :3 � CHECK NUMBER <br /> P.O.NUMBER <br /> CASH RECEIVED <br /> ROSS STREETS tAMOUnn) <br /> COMMODITY <br /> DTES: <br /> HALIDES <br /> NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIL/MIXED OILS) STATE CODE 221 <br /> *NO PLACARDS REQUIRED* <br /> NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE NEXT SERVICE DATE <br /> *NO PLACARDS OR MARKINGS REQUIRED* DRUMS DRUM SIZE <br /> OTHER , NO,OF GALLONS <br /> NIFEST NO. �--ter � , � � � <br /> j TRUCK NO.&R�. <br /> IVER <br /> USED OIL AND GASOLINE FILTERS <br /> SA RECYCLING, 33210 Western Avenue, Union City,CA 94587 1-510-487-9277 <br /> ALTERNATE FACILITY <br /> 95928 <br /> TSDF: ❑ ASBURY ENVIRONM00827844 <br /> ENTASERVICES CHICO 11,LLCenue e• 1618 W. 5th St.,Chico,CA95928•CAL980 561 6 •(8 <br /> ;IGNATED ❑ ASBURY ENVIRONMENTAL <br /> ASBURY ENVIRONMENTAL SERVICES-FOR u ida a Ln. *Bakersfield,rCA 93307 • CAL000282598 0(661)37710 <br /> ❑ BAKERSFIELD TRANSFER INC. •Dixo0 CA 95620 • CAT080012602 • (707)693-6008 -7100 <br /> ❑ D/K DIXON • 7300 Chevron Way • 90222 0 <br /> DEM • 2000 N. Alameda StrFeesno, CA 93722et 0 Compton, A CAD982446882 01(510)75560(916)371-5747 <br /> ❑ EVERGREEN ENV. • 4139 N.Valentine Ave. <br /> ❑ RAMOS ENVIRONMENTAL• 1515 S.R River Mann g Aver • Pa I er CA 93648 GAL000102751 • (559)498-02. <br /> ❑ ALTERNATE FACILITYRLD OIL-SAN OUIN, LLC <br /> ❑ properly classified,d <br /> This is to certify proper condition for transportation, according to ihe' <br /> )IL, USED ANTIFREEZE AND OILY WATER <br /> DTEMENNO/KERDOON THE and labeled, andareinepr per named at are p p <br /> :LED AT OUR SISTER COMP the Department of7rans ortation. <br /> ST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. p rt -��^—^ ��� <br /> :BY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY CUSTOMER SIGNATURE <br /> WASTE, THAT THE TOTAL HALIDES ARE LESS 1000 PPM.; <br /> -1-AW AKIV DX <br />