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NO,' 136119 <br />ASBURY ENVIRONMENTAL SERVICES <br />2100 NORTH ALAMEDA STREET ❑ COMPTON, CALIFORNIA 90222 ❑ (310( 886-3400 <br />EPA NO. CAD028277036 <br />SERVICE ORDER <br />DATE <br />CUSTOMER 6-1,' e — r <br />BILLING ADDRESS:' - t""r'-�4. <br />PHONE - <br />CUSTOMER EPA # <br />JOB SITE ADDRESS <br />CROSS STREETS <br />NOTES: <br />CONTACT <br />❑'COMBUSTIBLE LIQUID, N.O.S. (WASTE PETROLEUM OIL) <br />NA 1993, PG III <br />❑ ETHYLENE GLYCOL NON-RCRA <br />HAZARDOUS WASTE LIQUID NO PLACARD REQUIRED <br />❑ U.S. DOT DESCRIPTION: <br />n . <br />MANIFEST NO. <br />ONE TIME PICK UP <br />RESIDENT <br />CONTRACT CUSTOMER <br />ACCOUNT NUMBER <br />AMOUNT (If any) <br />CHECK NUMBER <br />P.O. NUMBER <br />6'YES or ❑ NO <br />❑ YES or MIN <br />❑ YES or Cr—N0 <br />CASH RECEIVED <br />(AMOUNT) <br />COMMODITY <br />HALIDES <br />NEXT SERVICE DATE <br />DRUMS <br />/ P.P.M. <br />NO. OF GALLONS �( <br />TRUCK NO. & RT <br />DESIGNATED TSDF: DeMenno/Kerdoon, 2000 N. Alameda Street, Compton, CA 90222, CAT080013352 <br />This is to certify that the above named articles are properly classified, described, packaged, <br />marked and labeled, and are in proper condition for transportation, according to the applicable <br />regulations of the Department of Transportation. <br />I HEREBY CERTIFY THAT I HAVE NOT MIXED <br />THIS WASTE WITH ANY OTHER WASTE, AND THE <br />TOTAL HALIDES ARE LESS THAN 1000 P.P.M. CUSTOMER SIGNATURE DATE <br />I FURTHER AGREE TO ACCEPT THE ADDITIONAL X —" <br />CHARGES FOR LEGAL DISPOSAL IF THIS WASTE PRINT NAME <br />IS OVER 1000 P.P.M. TOTAL HALIDES <br />