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3 O ' ' Ott v — FORM NO. AES003 <br /> �.. ., r SERVICE ORDER <br /> NO. N 902914 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S. SANTA FE AVENUE o COMPTON, CALIFORNIA 90221 o (310) 8861,13400 <br /> EPA# CAD028277036 v`� �} <br /> DIXON UNION CITY CHICO FRESNO 1 J ly <br /> 800-727-2879 888116031118844 800117331119043 866-994-6937 � v <br /> tt / <br /> DATE4 I 1 ONETIME PICKUP DYES or ONO <br /> CUSTOMER s{ (. 1 c' ! fir *C .4 4 /- <t 4 1, t f If' ., i t lt-: lkL ' ' ' RESIDENCE <br /> DYES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER I 'YES or ❑ NO <br /> PLEASE PAY FROM THIS <br /> • F c=;:=# � ';� SERVICE ORDER <br /> PHONE <br /> :..F. C Coe <br /> - CONTACT CUSTOMER NUMBER 2. <br /> It <br /> CUSTOMER EPA # .71 IBJ ( ( AMOUNT <br /> J08 SITE ADDRESS _ f a � -' S- ' I r' 1 't `l-- CHECK NUMBER <br /> sk, t � ."'� t ��. 4. ; P.O. NUMBER <br /> f <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY'i *` <br /> HALIDESP. F!M , <br /> NON-RCRA HAZARDOUS WASTE, LIQUID (USED OIL/MIXED OILS) STATE CODE 221 <br /> *NO PLACARDS REQUIRED* <br /> O 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 /> 1. <br /> MANIFEST N0. `c .✓ . ./ NO. OF GALLONS ' ! <br /> DRIVER _ ..._... c_ 4, : /9 ter w TRUCK NO. & RT. I / <br /> 0 USED OIL AND GASOLINE FILTERS <br /> ❑ SA RECYCLING, 33210-Western Avenue, Union City, CA 94587 1 -510487-9277 L E LN <br /> ❑ ALTERNATE FACILITY <br /> DESIGNATED TSDF: ❑ ASBURY ENVIRONMENTAL SERVICES • 2549 Scot Avenue • Chico, CA 95928 •. C L00 827P44 <br /> p ASBURY ENVIRONMENTAL SERVICES-CHICO Ii, LLC • 1618 W. 5th St. , Chico, A b CAD980fit34103 • (800) 733-9043 <br /> ❑ ASBURY ENVIRONMENTAL SERVICES-FORTUNA • 200 Dinsmore Dr., Fortuna, OA 9 1 !t <br /> ICAL930256136 • (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) 6931&6008 <br /> p DEMENNO/KERDOON • 2000 N. Alameda Street • Compton, CA 90222 • CAT080013352 • (310) 53707100 <br /> p 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 /> L9'' WORLD OIL-SAN JOAQUIN, LLC • 14287 E. Manning Ave. • Parlier, CA 93648 • CAL000102751 • (559) 498-0240 <br /> C1 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' m 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 /> *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 '4Hr; DATE <br /> *1 FURTHER AGREE TO ACCEPTTHE 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 />