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• SERVICE ORDER • FORM NO.AES001
<br /> SAN DIEGO OFFICE
<br /> 1-800-748-5744 — — —_-- SERVICE ORDER NO. .
<br /> NORTHERN OFFICE
<br /> 800-7-ASBURY
<br /> ASBURY ENVIRONMENTAL SERVICES
<br /> 1300 S.SANTA FE AVENUE • COMPTON,CALIFORNIA 90221
<br /> H : .i (310)886-3400 • FAX (310) 763-5922 Itl:ltl r, fc i.i!"
<br /> P EPA#CAD028277036
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<br /> CUSTOMER PURCHASE ORDER SALESMAN CONTACT .
<br /> i. I l` rit l'st!. F II
<br /> DATE REQUIRED SHIPPEDVIA DATE ENTERED CUSTOMER EPA ID NUMBER HALIDESP.P.M.
<br /> PLEASE PAY FROM THIS SERVICE ORDER
<br /> PRODUCT NO. QUANTITY DESCRIPTION ` U/M ORDERED SHIPPED B/O CUSTOMER COMMENTS
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<br /> i,J=� li�=I ai i11L a"tI�3 Pl• dJ;,�.` ,�.. :t,j€r �'��� '-� hRL:
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<br /> t.i 11041 '1tf`i3 `FIPVl.iit. tt1KC7t� ? �'
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<br /> WASTE DISPOSAL INFORMATION
<br /> NON-RCRA HAZARDOUS WASTE,LIQUIDPAYMENT INFORMATION
<br /> .(USED OIL/MIXED OILS) STATE CODE 221 f-
<br /> *NOPLACARDSREQUIRED' GALLONS: �-�.a 1 - '.AMOUNT(Ifany)
<br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID STATE CODE
<br /> ETHYLENE GLYCOL SOLUTIONS'NO PLACARDS REQUIRED" - DRUMS: CHECK NUMBER
<br /> ❑ NON-HAZ DRAINED USED OIL FILTERS FACILITY
<br /> El OTHER
<br /> DRUM SIZE'. -P.O.NUMBER.
<br /> MANIFEST NO. P-,,rr'�'�'lp`ll
<br /> CASH RECEIVED
<br /> TRUCK NO
<br /> ❑ DESIGNATED TSDF: DeMenno/Kerdoon, 2000 N Alameda Street, Compton, CA 90222, (310) 537-7100 CAT080013352
<br /> DESIGNATED TSDF•VA�vf ,, d Envjrgr 7ental, Inc., 1,3 9 6�hlttr m Avg F,q tpr}�/C/.�92 $ ,9) 356 90 �g7�gp0 57
<br /> ALTERNATE TSDF: �.I' r I ' I I�f.� '`� ' I .`' - }t / "7„%G a�C,' ,!A" C,r` d`G7`,rz'2.'�rt'J
<br /> VIOTES TO DRIVER
<br /> NEXT SERVICE DATE
<br /> la(1 I J ">:. ')'il ., „t.Fr ' I i. '; i&1 'f 0f"ll.1'11-h f0f, , I".t,g,.
<br /> I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WAST 'I l UkOM f4`11 01� 'A0,Fi l Z 0 '0 l +1t. L 13(:1;, 1 f-,", t,Fyf
<br /> WITH ANY OTHER WASTE, THAT THE TOTAL HALIDES ARE}
<br /> LESS THAN 1000 P.P.M.; AND THAT THE WASTE DOES NOT n :�! , I r i ,I %1 t a+ 133,1
<br /> .CONTAIN ANY P.C.B.'S. .4 `s 4+ .+.'i` '`_•i`� -
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<br /> I �i IRTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES1 I ,( •, L L3 ti71. f ,} ;;1 ri I i'E i i i'f,t[,T,1 �i!'C I)F;T : •tf,l_'c
<br /> .LEGAL DISPOSAL IF THIS WASTE IS OVER 1000 RPM! '
<br /> .L HALIDES,OR CONTAINS ANY P.C.B:S.
<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 /> DELIVERED-BY DATE
<br /> �l
<br /> E i j PRINT NAME (�. : 'I : I r ! ,.k:
<br /> RECEIVED BY 1 DATE SIGNATURE: DATE
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