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_- = SERVICE ORDER <br /> NO. N 14113 <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 1-800-727-2879 <br /> 1-800-933-9194 <br /> DATE �'�6' DU ONE TIME PICK UP ❑ YES or ❑ NO <br /> CUSTOMER 64-X Oh RESIDENT ❑ YES or ❑ NO <br /> BILLING ADDRESS 45 57� CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PHONE«7 — ( W —S 3/� CONTACT ACCOUNT NUMBER v �v <br /> CUSTOMER EPA if AMOUNT <br /> JOB SITE ADDRESS CHECK NUMBER <br /> P.O. NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY <br /> HALIDES P.P.M. <br /> ❑COMBUSTIBLE LIQUID, N.O.S., <br /> (Used Oil/Contaminated Petroleum Products), NA1993, PGIII <br /> ❑RQ, ENVIRONMENTALLY HAZARDOIJJS SUBSTANCES, LIQUID, <br /> NOS, (Ethylene Glycol &Water), 9, N3082, PGM NEXT SERVICE DATE �[ <br /> ❑ U.S. DOT DESCRIPTION: � <br /> DRUMS <br /> MANIFEST NO. NO.OF GALLONS <br /> DRIVER TRUCK NO. &RT <br /> DESIGNATED TSDF: ❑ ALVISO INDEPENDENT OIL- 5002 Archer St. -Alviso, CA 95002 <br /> ❑ BAYSIDE TOIL Il, INC. - 210 Encinal St. - Santa Cruz, CA 95060 <br /> ❑ BC STOCING - 7300 Chevron Way Dixon, CA 95620 <br /> ❑ DeMENN /KERDOON - 2000 N. Alameda St. - Compton, C <br /> ❑ OCS - 32 6 N. Marks St. - Fresno, CA 93722 <br /> ❑ RAMOS ENVIRONMENTAL- 1515 S. River Road - W. Sacramento, C 95691 <br /> This is to certify th the above na ed a icles are properly classified, described, packaged, <br /> marked and lab d,and are' rope c ndition for transportation,according to the applicable <br /> regulations o e Depart of Trans ortation. <br /> I HEREBY CERTIFY THAT I HAVE NOT MIXED x –� ��� <br /> THIS WASTE WITH ANY OTHER WASTE,AND THE <br /> TOTAL HALIDES ARE LESS THAN 1 0 P.P.M. CUSTOMER SIGNATURE DATE <br /> I FURTHER AGREE TO ACCEPT TH ADDITIONAL X <br /> CHARGES FOR LEGAL DISPOSAL I THIS WASTE <br /> IS OVER 1000 P.P.M.TOTAL HALIDES PRINT NAME <br />