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No. H417376 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 2100 NORTH ALAMEDA STREET ❑ COMPTON, CALIFORNIA 90222 ❑ (310) 886-1810 <br /> SAN DIEGO.OFFICE NORTHERN.OFFICE <br /> 1-800-748-5744 EPA No.cADo2s277oas 1-800-7ASBURY <br /> SERVICE ORDER <br /> 4 ! S —C>1 ONE TIME PICK UP ❑ YES or ❑ No <br /> DATE _ <br /> CUSTOMER -� RESIDENCE ❑ YES or ❑ NO <br /> BILLING ADDRESS 3 5aD `-A7,A VJ L CONTRACT CUSTOMER ES or ❑ NO <br /> rk� 1 ter+ 9 __!5_20-1 <br /> PHONE zc q �,Js- -4`o/ CONTACT CUSTOMER NUMBER <br /> CUSTOMER EPA q Gt1L � /Q — AMOUNT �D <br /> JOB.SITE ADDRESS J✓ �� �tl Z "',A� CHECK NUMBER <br /> P.O. NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES:- Fx1 ' _Ly COMMODITY <br /> HALIDES P.P.M. <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS) STATE CODE <br /> ❑ `NO PLACARDS REQUIRED' - - <br /> ❑ NON-RCRA HAZARDOUS'WASTE,LIQUID`IETHYLENE GLYCOL SOLUTION) STATE CODE <br /> 'NO PLACARDS OR MARKINGS REQUIRED'._ NEXT SERVICE DATE <br /> ❑ OTHER DRUMS DRUM SIZE <br /> MANIFEST NO. T' NO.OF GALLONS <br /> DRIVER TRUCK NO.&RT. <br /> ❑ NON-HAZARDOUS DRAINED USED OIL FILTERS <br /> ❑DESIGNATED TSDF: DeMenno/Kerdoon, 2000 N.Alameda Street, Compton, CA 90222, (310)537-7100, CAT080013352 <br /> ESIGNATEDTSDF:Advanced Environment I, Inc., 13579 hittram Ave., Fontana, CA 92 35, (909)356-0245, CAT080025711 <br /> LTERNATE TSDF: � 1� �' �1f SO/� , , ����� <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 th epartment of Transportation. <br /> I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE �/ \ <br /> WITH ANY OTHER_ WASTE,THAT THE TOTAL HALIDES ARE X <br /> LESS THAN 1000 P.P.M.; AND THAT THE WASTE DOES NOT CUSTOMER SIGNATURE DATE <br /> CONTAIN ANY P.C.B'S. <br /> I FURTHER AGREE TO AEPT THE ADDITIONAL CHARGES <br /> FOR LEGAL DISPOSAL IF THIS WASTE IS OVER 1000 P.P.M. <br /> TOTAL HALIDES,OR CONTAINS ANY P.C.B'S. X ` <br /> PRINT NAME <br />