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FORM NO , AES003 <br /> SERVICE ORDER <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S . SANTA FE AVENUE ❑ COMPTON , CALIFORNIA 90221 ❑ ( 310 ) 886-3400 <br /> EPA# CAD028277036 f� <br /> DIXON UNION CITY CHICO FRESNO / <br /> 800-727-2879 888-603-8844 800-733-9043 866-994-6937 <br /> DATE ONETIME PICKUP El YES or ❑ NO <br /> e <br /> CUSTOMER f a i�, , _ RESIDENCE El YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER CZ_ YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> SERVICE ORDER <br /> PHONE f ` CONTACT CUSTOMER NUMBER <br /> CUSTOMER EPA # _ AMOUNT <br /> JOB SITE ADDRESS - CHECK NUMBER <br /> {« P. O. NUMBER <br /> f <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES : COMMODITY <br /> SEP 0 6 2016 <br /> R <br /> HALIDES P. P. M . <br /> A <br /> Ali <br /> 01 <br /> E` NON -RCRA HAZARDOUS WASTE, LIQUID (USED OIL/MIXED OILS) STATE CODE 221 <br /> *NO PLACARDS REQUIRED* <br /> 3 <br /> ❑ NON -RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> *NO PLACARDS OR MARKINGS REQUIRED* NEXT SERVICE DATE <br /> ❑ OTHER DRUMS DRUM SIZE <br /> MANIFEST NO. ' t `- NO. OF GALLONS J <br /> .Tle <br /> DRIVER TRUCK NO. & RT. / <br /> _r s' — <br /> ❑ USED OIL AND GASOLINE FILTERS <br /> ❑ SA RECYCLING , 33210 Western Avenue, Union City, CA 94587 1 -510-487-9277 <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ ASBURY ENVIRONMENTAL SERVICES • 2549 Scot Avenue • Chico , 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. , Fortuna, 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) 693-6008 <br /> ❑ DEMENNO/KERDOON • 2000 N . Alameda Street • Compton , CA 90222 • CAT080013352 • (310) 537-7100 <br /> ❑ EVERGREEN ENV, • 4139 N . Valentine Ave. • Fresno, CA 93722 • CAD982446882 • (510) 795-4400 <br /> ❑ RAMOS ENVIRONMENTAL • 1515 S . River Road • W. Sacramento , CA 95691 • CAD044003556 • (916) 371 -5747 <br /> ❑�' WORLD OIL-SAN JOAQUIN, LLC • 14287 E . Manning Ave . • Parlier, CA 93648 • CAL000102751 • (559) 498-0240 <br /> 0 ALTERNATE FACILITY <br /> USED OIL, USED ANTIFREEZE AND OILY WATER WASTE STREAMS ARE This is to certify that the above named articles are properly classified , described , packaged , marked <br /> RECYCLED AT OUR SISTER COMPANY DEMENNO/KERDOON THE and labeled , and are in proper condition for transportation, according to the applicable regulations of <br /> LARGEST RECYCLER OF USED OIL IN THE WESTERN UNITED STATES. the Department of Transportation . <br /> *1 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. PRINT NAME <br />