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• <br />FORM NO. AES003 <br />SERVICE ORDER <br />No. N 6r)"11, <br />ASBURY ENVIRONMENTAL SERVICES <br />1300 S. SANTA FE AVENUE ❑ COMPTON, CALIFORNIA 90221 ❑ (310) 886-3400 <br />SAN DIEGO OFFICE NORTHERN CALIFORNIA <br />1-800-748-5744 EPA CAD028277036 1-800-727-2879 <br />DATE <br />CUSTOMER _ <br />BILLING ADDRESS <br />PHONE <br />_.. CONTACT <br />CUSTOMER EPA # "' J , <br />JOB SITE ADDRESS <br />CROSS STREETS <br />NOTES: <br />U NUN-HCRA HAZARDOUS WASTE, LIQUID (USED OIUMIXED OILS) STATE CODE 221 <br />*NO PLACARDS REQUIRED* — <br />❑ NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br />*NO PLACARDS OR MARKINGS REQUIRED* <br />❑ OTHER <br />MANIFEST NO. - -. <br />O NONHAZARDOUS DRAINED USED OIL FILTER <br />❑ COMMERCIAL FILTER RECYCLING, 33210 Western Avenue, Union City, CA, 510-487-9277 <br />❑ ALTERNATE FACILITY <br />ONE TIME PICKUP <br />RESIDENCE <br />DYES or ❑NO <br />❑ YES or ❑ NO <br />CONTRACT CUSTOMER ❑ YES or ❑ NO <br />CUSTOMER NUMBER <br />AMOUNT <br />CHECK NUMBER <br />P.O. NUMBER <br />CASH RECEIVED <br />(AMOUNT) <br />COMMODITY <br />HALIDES <br />133 <br />NEXT SERVICE DATE <br />DRUMS DRUM SIZE <br />NO. OF GALLONS <br />TRUCK NO.8 RT. - - <br />DESIGNATED TSDF: ❑ ALVISO INDEPENDENT OIL - 5002 Archer Street • Alviso, CA 95502 • CAL000161743 . (510) 476-1740 <br />❑ BAYSIDE OIL 11, INC. • 210 Encinal Street • Santa Cruz, CA 95060 • CAD088838222 • (408) 427-3778 <br />❑ EVERGREEN ENV.. 4139 N. Valentine Ave. • Fresno, CA 93722 . CAD982446882. (510) 7954400 <br />❑ DEMENNO/KERDOON • 2000 N. Alameda Street • Compton, CA 90222 • CAT080013352 • (310) 537-7100 <br />❑ D/K DIXON . 7300 Chevron Way. Daon, CA 95620. CAT080012602. (707) 693-6008 <br />0 RAMOS ENVIRONMENTAL. 1515 S. River Road . W. Sacramento, CA 95691 . CAD044003556 .(916) 371-5747 <br />❑ ASBURY ENVIRONMENTAL SERVICES • 2549 Scott Avenue • Chico, CA 95928 • CAL000827844 <br />❑ ALTERNATE FACILITY <br />P.P.M. <br />USED OIL, USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE is to <br />This <br />RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE certify that the above named articles are properly classified, described, packaged, marked <br />LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. and labeled, and are in proper condition for transportation, according to the applicable regulations of <br />the Departinent of Transportation.. <br />*I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br />OTHER WASTE, THAT THE TOTAL HALOES ARE LESS THAN 1000 P.P.M.; X /- <br />AND THAT THE WASTE DOES NOT CONTAIN ANY RC.B'S_ CUSTOMER SIGNATURE <br />DATE <br />-1 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 NAUF <br />