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FORM NO.AES003 <br /> SERVICE ORDER <br /> No. N 580622 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE ❑ COMPTON, CALIFORNIA 90221 ❑ (310) 886-3400 <br /> SAN DIEGO OFFICE NORTHERN CAUFORNIA <br /> 1-800-748-5744 EPA CAD028277036 1-800-727-2879 <br /> J <br /> DATE ONE TIME PICKUP El YES or ❑NO <br /> CUSTOMER RESIDENCE ❑ YES or ❑ NO <br /> BILLING ADDRESS - - CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <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 /> -- -,` (AMOUNT) <br /> -S: COMMODITY <br /> HALIDES P.P.M. <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 133 <br /> *NO PLACARDS OR MARKINGS REQUIRED* NEXT SERVICE DATE <br /> OTHER DRUMS DRUM SIZE <br /> MANIFEST NO. . .. NO.OF GALLONS <br /> DRIVER TRUCK NO.&RT. <br /> ❑ NONHAZARDOUS DRAINED USED OIL FILTER <br /> ❑ COMMERCIAL FILTER RECYCLING,33210 Western Avenue, Union City,CA,510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ ALVISO INDEPENDENT OIL-5002 Archer Street•Alviso,CA 95502•CAL000161743.(510)476-1740 <br /> ❑ BAYSIDE OIL II,INC.•210 Encinal Street•Santa Cruz,CA 95060•CA0088838222• (408)427-3778 <br /> ❑ EVERGREEN ENV. .4139 N. Valentine Ave. . Fresno,CA 93722.CAD982446882 .(510) 795-4400 <br /> ❑ DEMENNO/KERDOON •2000 N.Alameda Street•Compton,CA 90222•CAT080013352•(310)537-7100 <br /> ❑ DIK DIXON.7300 Chevron Way•Dixon,CA 95620.CAT080012602•(707)693-6008 <br /> ❑ RAMOS ENVIRONMENTAL.1515 S.River Road .W.Sacramento,CA 95691.CA0044003556 .(916)371-5747 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES•2549 Scott Avenue•Chico,CA 95928•CAL000827844 <br /> ❑ ALTERNATE FACILITY <br /> IIL,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE <br /> AE:. -SLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE This is to 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 Department of Transportation. <br /> *I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br /> OTHER WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.; 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 f' - ' / <br /> CONTAINS ANY P.C.B'S. - PRINT NAME <br />