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1010802010 09:53 fAX) P.0041045 <br />FORM NO. AEM <br />m <br />ASBURY EWRONMENTAL SERVICES <br />1300 S. SANTA FE AVENUE D COMPTON, CALIFORNIA 90221 0 (310) 886-3400 <br />SAN DIEGO OFFICE NORTHERN CALIFORNIA <br />1400-748-5744 ENA GAD028277036 1-800-727-2879 <br />/�-c <br />CUSTOMER <br />e .. <br />PHONE •L/ �? �+ (i~ S ��rJ® CONTACT <br />21 r�fj 11a <br />HAZARDOUS WASTE, LIQUID (USED OILIMIXED OILS) STATE CODE <br />PLACARDS REQUIRED' <br />• -,. •�1 � F111 VAN [It il�'AVAOIV I I I 1161 <br />�711�131 <br />❑ COMMERCIAL FILTER RECYCLING, 33210 Western Avenue, Union City, CA, 610.487-0271 <br />0 ALTERNATE FACILITY <br />ONE TIME PICT{ UP ❑ YES or ONO <br />RESIDENCE M YES Or 0 NO <br />PLEASE PAY FROM THIS <br />SERVICE ORDER <br />CUSTOMER NUMBER <br />CHFOtNUMBER <br />P.O. NUMBER <br />CASH RECEIVED <br />COMMODITY <br />4f <br />HAUDESs` <br />D. -I's -As <br />w r a Y7: <br />NO. OF * <br />y <br />IRVQK NO. <br />DESIGNATED TSDF: ® ALVISO INDEPENDENT OIL- 6402 ArdW SOV9 * AM2o. CA 05662 * CAL000181743 . (810) 476.1740 <br />O SAYSIDIR OL 11, INC. * 210 Enchal Street • Sents Cruz, CA 95M - CARO * (408) 427.3778 <br />13 EVERGREEN ENV. ® 4139 N. Valertt(ne Amo Fresno, CA 93722 ® CAD982446W ® (510) 795-4400 <br />DENISNNO/KERDMN * 2.000 N. AMmeda St iM * Oompton. CA 00222 * CATO84O13352 * (310) 837-7100 <br />PD DIK DIXON e 7300 Way • , CA • CA 12812 • (707) R <br />C] RAMOG ENVIRONMENTAL* 1616 S. WiW Rad *W. 311110MININKft CA 9W • CA (9I6) 371-(,1747 <br />® ASBURY ENVIRONMENTAL SERVICES, 2645 Sco to * Chi= CA 88828 • 844 <br />q ALTERNATE FACILITY <br />YSED 01" li■ED AWWREEM AND OA -Y WATER WASTE STREAMS ARE <br />RECYRLSD AT OUR SISTER COMPANY DEMENNOMERDOON THE <br />.rn <br />LARGEST REOSYCLER OP USED OIL IN THE WESTERN N S'I'ATK& <br />an <br />ew <br />*t HERESY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY <br />OTHER WASTE, THAT THE TOTAL KAU066 ARE LESS THAN logo P.P.M.; <br />X <br />AND THAT THE WASTE DOES NCR' CONTAIN ANY P40S.. <br />*1 FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGE43 FOR LEGAL <br />r <br />DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M. TOtAL HALIDES, OR <br />X <br />CONTAINS ANY PC.WS. <br />ft sbum named articles aro prowl, olaoslfled, daecr1lod msrkatl <br />Iq N*qW condition is tram oc�rdirt0 to the apgitceblp r�uiat a of <br />r S <br />