Laserfiche WebLink
SERVICE ORDER FORM NO.AES001 <br /> SAN DIEGO OFFICE <br /> 1-800-748-5744 - - —_-- SERVICE ORDER NO. <br /> NORTHERN OFFICE It;L; <br /> 1-800-7-ASBURY <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 1300 S.SANTA FE AVENUE • COMPTON,CALIFORNIA 90221 <br /> IS <br /> M AUTO SPFC:'TALI 1.1 (3101886-3400 • FAX(310) 763-5922 <br /> P7719 W. 111H "�llt l=z� �' EPA#CAD028277036 k/1.0 '14. III-fill LiWIc�_T <br /> P <br /> E <br /> D <br /> T TR=ACY. Ci, TRAL"Y. CA Y!,43144 <br /> D "001 ) <s.{,3_.. k ('f'v1 (.111091) <br /> CUSTOMER PURCHASEORDER SALESMAN CONTACT <br /> r.r <br /> DATE REQUIRED SHIPPED VIA DATE ENTERED CUSTOMER EPA ID NUMBER HALIDES P.P.M. <br /> r .'kiti_ , :111'' i it`,?C)C'1'7 [ rat i!•r!" 1 :. <br /> PLEASE PAY FROM THIS SERVICE ORDER <br /> PRODUCT NO. DESCRIPTION U/M QUANTITY <br /> ORDERED SHIPPED 1 Btp CUSTOMER COMMENTS <br /> >II tl�. t1k1 t 3• e.,fi' fi.. tii. lf.) {? . 5, , g,;i <br /> WASTE DISPOSAL INFORMATION PAYMENT INFORMATION <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIL/MIXED OILS1 STATE CODE 221 { <br /> 'NO PLACARDS REQUIRED" GALLONS: _ AMOUNT(If any) v <br /> ❑ NON-RCRA HAZARDOUS WASTE,LIQUID STATE CODE <br /> ETHYLENE GLYCOL SOLUTIONS*NO PLACARDS REQUIRED' DRUMS: CHECK NUMBER <br /> L•3 NON-HAZ DRAINED USED OIL FILTERS FACILITY__T____ <br /> � <br /> _ DRUM SIZE: _ P.O.NUMBER <br /> El OTHER: _ .`L"I t" Lift,�' 1 L�J011 A <br /> MANIFEST NO. ate. .. CASH RECEIVED <br /> TRUCK NO. -,r <br /> ❑ DESIGNATED TSDF: DeMenno/Kerdoon, 2000 N. Alameda Street,Compton,CA 90222, (310) 537-7100, CAT080013352 <br /> ❑ DESIGNATED TSDF:Advanced Environmental, Inc., 13579 Whittram Ave., Fontana,CA 92335, (909) 356-9025,CAT080025711 <br /> ❑ ALTERNATE TSDF: <br /> NOTES TO DRIVER <br /> NEXT SERVICE DATE <br /> L t.. -Ft , T; it,t'iLDIA1 L_L_ Y Ah1TiFt l F-ZE RI:L-f(At <br /> I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WAS 'I It+L'r,rt b;.i4,.1.. &E, L:AI.,GULA I-F-Jt AS FOLLCIWS i ER 6AL. <br /> WITH ANY OTHER WASTE, THAT THE TOTAL HALIDES ARE'1F" 1 R „-•(:. FIJtfC:NIY`ak;l3p<r (:SAL. P/Lt G 14t) <br /> LESS THAN 1000 P.P.M.;AND THAT THE WASTE DOES NO1l'' „ _ <br /> CONTAIN ANY P.C.B.'S. 49 ^�kt it 4 i'Ilh�1FIPi L P 1. (WA, P/U Cr. tap GWif:L,t. <br /> I FURTHER AGREE TO ACCEPT THE ADDITIONAL CHARGES <br /> FOR LEGAL DISPOSAL IF THIS WASTE IS OVER 1000 P.PivoV . I, L I, '0 1` 't1 Wll L PC CHARGED ACC:1LRDIW ,Y <br /> TOTAL 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 /> DELIVERED BY DATE I <br /> regulations of the Department of Transportation. <br /> PRINT NAME <br /> ` r <br /> RECEIVED BY - DATE SIGNATURE: DATE /c; /t"-+ <br />