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s FORM NO. AES003 <br />ay SERVICE ORDER <br />ASBURY ENVIRONMENTAL SERVICES <br />1300 S. SANTA FE AVENUE `d COMPTON, CALIFORNIA 90221 ❑ (310) 886-3400 <br />EPA# CAD028277036 <br />DIXON UNION CITY CHICO <br />800-727-2879 % 888-603-8844 800-733-9043 <br />DATE 3 ONETIME PICK UP DYES or <br />CUSTOMER<1.—e. S 6{n ) 7 RESIDENCE ❑ YESol�/NO <br />BILLING ADDRESS 6 CONTRACT CUSTOMER 10"YES or ❑ NO <br />PLEASE PAY FROM THIS <br />(p3 1 SERVICE ORDER <br />PHONE t� CONTACT CUSTOMER NUMBER d <br />CUSTOMER EPA # ` AMOUNT <br />JOB SITE AD ESS l (D CHECK NUMBER <br />Z) P.O. R NUMB <br />V'1 � E <br />I CROSS STREETS <br />NOTES: <br />CASH RECEIVED <br />A +�IAMouNn <br />COMMODITY <br />HALIDES P.P.M. <br />❑NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIL/MIX�D OILS) STATE CODE 221 <br />12"*NO CARDS REQUIRED* <br />4 <br />NON-RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GL�COL SOLUTIONS) STATE CODE <br />*NO PLACARDS OR MARKINGS REQUIRED* NEXT SERVICE DATE <br />❑ OTHER 1 DRUMS DRUM SIZE <br />MANIFEST NO. Orb ?S NO. OF GALLONS <br />DRIVER 1 TRUCK NO. & RT.� <br />❑ USED OIL AND GASOLINE F ERS <br />a, <br />11 SA RECYCLING, 33210 Western Avenue, Union City, CA 94567 1-510-487-9277 <br />❑ ALTERNATE FACILITY <br />DESIGNATED TSDF: ❑ ASBURY ENVIRONMENTAL SERVICIS • 2549 Scot Avenue • Chico, CA 95928 • CAL000827844 <br />El ASBURY ENVIRONMENTAL SERVIC-CHICO 11, LLC • 1618 W. 5th St., Chico, CA 95928 • CAD980694103 • (800) 733-9043 <br />El ASBURY ENVIRONMENTAL SERVIC-FORTUNA • 200 Dinsmore Dr., Fortuna, CA 95540 • CP L930256136 • (800) 733-9043 <br />❑ BAKERSFIELD TRANSFER INC. • 1 E. Brundage Ln. • Bakersfield, CA 93307 • CAL000282598 • (661) 377-0308 <br />0 D/K DIXON • 7300 Chevron Way • Di, CA 95620 • CAT080012602 • (707) 693-6008 <br />❑ DEMENNO/KERDOON • 2000 N. Alameda Street • Compton, CA 90222 • CAT080013352 • (310) 537-7100 <br />❑ PMRGREEN ENV. • 4139 N. Valentind Ave. • Fresno, CA 93722 • CAD982446882 • (510) 795-4400 <br />❑ SAN JOAQUIN FILTER RECYCLING 14287 E. Manning Ave. • Parlier, <br />El ALTERNATE FACILITY <br />A 93648 • CAL000102751 • (559) 498-0240 <br />USED OIL, USED ANTIFREEZE AND OILY WATER WASTE STREAMS A E <br />RECYCLED AT OUR SISTER COMPANY DEMENNO(KERDOON T�YE <br />This is to certify that above <br />ed=properly, described, packaged, marked <br />LARGEST RECYCLER OF USED OIL IN THE WESTERN. UNITED STA'71 S. <br />and labeled, ndae roper c <br />the De artm of Tra sp rtation.*1 <br />itio to the applicable regulabo s of <br />HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH A JY <br />OTHER WASTE, THAT THE TOTAL HALIDES ARE 4.; <br />X <br />LESS THAN 1000 PP <br />AND THAT THE WASTE DOES NOT CONTAIN ANY P.C.B'S.. ( <br />s <br />ME IGNATu <br />DATE <br />% FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES FOR LEGIAL <br />X <br />,. <br />DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M. TOTAL:hiALIDES. IR <br />CONTAINS ANY P.C.B'S. <br />PRINT NAME <br />