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FORM NO.AES003 <br /> SERVICE ORDER <br /> No. N 585047 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S. SANTA FE AVENUE ❑ COMPTON,CALIFORNIA 90221 o (310) 886-3400 <br /> SAN DIEGO OFFICE NORTHERN CALIFORNIA <br /> 1-800-748-5744 EPA CAD028277036 1-800-727-2879 <br /> DATE M- 7 `' -f ONE TIME PICKUP ❑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 /> FS: 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.&FIT <br /> Pt/NON HAZARDOUS 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 ll,INC.•210 Encinal Street•Santa Cruz,CA 95060•CAD088838222•(408)427-3778 - <br /> O 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 /> ❑ D/K DIXON•7300 Chevron Way.Dixon,CA 95620•CAT080012602•(707)693-6008 - <br /> ❑ 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 /> 4L,USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to certify that the above`named articles are properly classified, described, packaged, marked <br /> E—,;LED AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled, and'are in proper condition ter transportation, according to the applicable regulations of <br /> -ARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Department of Transportation. <br /> N 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 X <br /> DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M.TOTAL HALIDES, OR <br /> CONTAINS ANY P.C.B'S. PRIM NAME <br />