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Nov 08, 11 12:07p • • p.4 <br /> FORM NO.AES003 <br /> - _-- - SERVICE ORDER <br /> � — — No. N _ .: -. � : <br /> ASBURY ENVIRONMENTAL SERVICES <br /> '1300 S.SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221 ❑ (3]D)886-3400 <br /> EPA#CAD028277M <br /> DIXON UNION CITY CHICO <br /> 800-727-2879 8888-603-8844 800-733-9043 <br /> DATE � '' ' r f ONETIMEPICKUP ❑YES or ONO <br /> CUSTOMER RESIDENCE DYES Or ❑ NO <br /> BILUNGADDRESS CONTRACTCUSTOMER ❑YESor ❑ NO <br /> PLEO'"'s-E. FROM THIS <br /> PHONE - CONTACT CUSTOMER NUMBER <br /> CUSTOMER EPA# AMOUNT <br /> JOB SITE ADDRESS - CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> IAMOUNTI <br /> NOTES: COMMODITY <br /> HALIDES - P.P.M. <br /> 6''NON-RCRA HAZARDOUS WASTE,LIQUID(USED OILIMIXED 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" NEXT SERVICE DATE <br /> ❑ OTHER /' Q(� )� /I'� DRUMS DRUM SIZE <br /> MAAIIFEST NO. _ 6//jy� y't{.'7y7 I Li ^— NO.OF GALL0NIS /=-L5_451 <br /> DRIVER TRUCK NO.&R-0 <br /> ❑ USED OIL AND GASOLINE FILTERS <br /> ❑ SA RECYCLING, 33210 Western Avenue,Union City,CA 94587 1-510-487-9277 <br /> 0 ALTFRNAT6 FACILITY <br /> DESIGNATED TSDF: D ASBURY ENVIRONMENTAL SERVICES'2549 Scot Avenue-Chico,CA 95928-CAL000827841 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES-CHICO II,LLC-1618 W.5th St.,Chico,CA 95928-CAD98❑B94103-(800)733-9043 <br /> • ASBURY ENVIRONMENTAL SERVICES-FORT'UNA-200 Dinsmore Dr.,Fortuna,CA 95540-CALS30256136-(800)733-9043 <br /> ❑ BAKERSFIELD TRANSFER INC. -1620 E.Brundage IT.-Bakersfield,CA 93307-CALOOD282598 -(661)377-0308 <br /> 0..D/K DIXON-7300 Chevron Way-Dixon,CA 95620-CAT080012602-(707)693-6006 <br /> -'L'1-DEMENNOIKERDOON-2000 N.Alameda Street-Compton,CA 90222- CAT080013352'(310)537-7100 <br /> D EVERGREEN ENV.-4135 N.Valentine Ave.*Fresno,CA 93722-CAD982446882-(510)7954400 <br /> ❑ RAMOS ENVIRONMENTAL-1515 S.River Road-W.Sacramento,CA 95691 -CAD044003555-(916)371-5747 <br /> ❑ SAN JOAQUIN FILTER RECYCLING-14287 E Manning Ave. -Paslier,CA 93648-CALOCOI02751 -(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 arfides are properly classified,described,packaged, marked <br /> RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled.and are in proper condition for transportation,according to the applicable regulations el <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UWTFD STATES. the DePanment of Transportation. <br /> OTHER-1 HEREBY TAT I HAE NOTTHIS WASTE NTH ANY <br /> WASTEflTIFY HAT THE TOTAL 14AUDESXARE ED LESS T14AN 1000 PP" X <br /> AND THATTHE WASTE DOES NOT CONTAIN ANY P.C.S'S.. CUSTOMER SIGNATURE 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 NAME <br />