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NO. ` 1J I, <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 2100 NORTH ALAMEDA STREET❑ COMPTON, CALIFORNIA 90222 ❑ (310) 886-3400 <br /> SAN DIEGO OFFICE "NORTHERN OFFICE <br /> 1-800-748-5744 EPA NO. CAD028277036 1-800-7 ASBURY <br /> SERVICE ORDER ; +� <br /> / <br /> DATE ' <''-�f- i _ ONE TIME PICK UP ❑ YES or ❑ NO <br /> t (.% <br /> CUSTOMER ' N tf�% y � RESIDENT El YES or ❑ NO <br /> BILLING ADDRESS s z_ !lf �" ' �f('/ '' CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> d 4 3 CONTACT ACCOUNT NUMBER <br /> - <br /> o <br /> CL <br /> CUSTOMER EPA tl AMOUNT (If any) <br /> JOB SITE ADDRESS CHECK NUMBER <br /> f P.O. NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: t �� ` ' `�" f COMMODITY <br /> HALIDES P.P.M. <br /> ❑ NON RCRA HAZARDOUS WASTE LIQUID(Used Oils/Mixed Oils)NO PLACARD REQUIRED <br /> ❑ NON RCRA HAZARDOUS WASTE LIQUID,CALIFORNIA REGULATED WASTE ONLY <br /> (Glycol&Water)NO PLACARDS REQUIRED NEXT SERVICE DATE <br /> ❑ OTHER DRUMS DRUM SIZE [� <br /> MANIFEST NO. NO.OF GALLONS <br /> DRIVER TRUCK NO.&RT. <br /> ❑ NON HAZARDOUS DRAINED USED FILTERS <br /> ❑ DESIGNATED TSDF:DeMenno/Kerdoon,2000 N.Alameda Street,Compton,CA 90222, CAT080013352 <br /> ❑ DESIGNATED TSDF:Advanced Environmental, 13579 Whittram Ave.,Fontana,CA 92335,CAT080025711 <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 /> ii _ <br /> I HEREBY CERTIFY THAT I HAVE NOT MIXED <br /> THIS WASTE WITH ANY OTHER WASTE,AND THE X <br /> TOTAL HALIDES ARE LESS THAN 1000 P.P.M. CUSTOMER SIGNATURE DATE <br /> I FURTHER AGREE TO ACCEPT THE ADDITIONAL v <br /> CHARGES FOR LEGAL DISPOSAL IF THIS WASTE X �— <br /> IS OVER 1000 P.P.M.TOTAL HALIDES PRINT NAME <br />