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Nov 0$ 11 12:08p • • P•5 <br /> FORM NO.AESW3 <br /> SERVICE ORDEF <br /> NO N `` 6z,53`I <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE ❑ COMPTON, CALIFORNIA 90221 o (310) 886-3400 <br /> EPA#CAD028277036 <br /> DIXON UNION CITY CHICO <br /> BOD-727-2879 888-603-SB44 800-733-9043 <br /> DATE z/,F� © "� / ONETIME PICK UP El YES or ONO <br /> CUSTOMER RESIDENCE ❑YES or ❑ NO <br /> eILUNG ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER,.. <br /> PHONE -. - CONTACT - CUSTOMER NUMBER <br /> CUSTOMEREPA# -- AMOUNT <br /> JOB SITE ADDRESS - • - - - CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES; COMMODITY <br /> HALIDES P.P.M. <br /> ❑ NON-RCRA HAZARDOUS WASTE,UQU1D(USED OIL/MIXED 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 ,tea DRUMS DRUM SIZE <br /> MANIFESTNO. f /• +�r�' -' �.I rI NO-OF GALLONS <br /> DRIVER TRUCK TRUCK NO.&Frr, •1n /1 <br /> ❑ USED OIL AND GASOLINE FILTERS <br /> ❑ SA RECYCLING, 33210 Western Avenue,Union City,CA 94587 1-51D-487-9277 <br /> Cl ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ ASBURY ENVIRONMENTAL SERVICES•2549 Scot Avenue•CNco,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.,Fortune,CA 95540•CAL930256136•(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)693-6006 <br /> ❑ DEMENNO/KERDOON •2000 N.Aiameda Street•Compton, CA 90222•CAT180013352•(3401537.7100 <br /> Cl EVERGREEN ENV.•4139 N.Valentine Ave.•Fresno,CA 93722•CAD982446882•(510)795-4400 <br /> ❑ RAMOS ENVIRONMENTAL•1515 S.River Road•W.Sacramento,CA 95691 •CAD044OD3556•(916)371-5747 <br /> ❑ SAN JOAQUIN FILTER RECYCLING•14287 E.Manning Ave. •Parlier,CA 93E48•CAL0001 D2751 •(559)498-0240 <br /> ❑ ALTERNATE FACILITY <br /> USED OIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This Is to cert' that the above named anieles are ro <br /> RECYCLED AT OUR SISTER COMPANY DEMENNOIKERDOON THEhAled- n P Perp=dassiGed,described,packaged,marketl <br /> LnROGOT wGOYctEw <br /> OF YOCD OIL IN Ti IG v=oO DN UNrrLD omnrrco. the Wpartm arltl a ,n Wooer eentlitinn Snr transnnn��inn. nnnM;np en fF,..,.prnrolye•aa,.,.c.,..er <br /> the Department of fransporta0on. <br /> •1 HEREBY CERTIFY THAT I HAVE NOT MEXED THIS WASTE WITH ANY <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 RPM.; 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 P.P.M.TOTAL HALIDES, OR X <br /> r1(WTAINR ANY PC.R'R oou...nue <br />