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--- SERVICE ORDER <br /> No. N 1� S <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 2100 NORTH ALAMEDA STREET ❑ COMPTON, CALIFORNIA 90222 o (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 - ONE TIME PICK UP ❑ YES or ❑ NO <br /> CUSTOMER RESIDENT ❑ YES or.❑ NO <br /> BILLING ADDRESS ts: CONTRACT CUSTOMER ❑ YES or O NO <br /> PHONE 'S�. `' CONTACT ACCOUNT NUMBER <br /> CUSTOMER EPA# � _ ''{ AMOUNT <br /> JOB SITE ADDRESS =fie " CHECK NUMBER <br /> P.O. NUMBER <br /> CROSS STREETS "" CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY "t <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 'r'' �' ` <br /> DRIVER TRUCK NO.&RT. <br /> ❑ NON HAZARDOUS DRAINED USED FILTERS <br /> DESIGNATED TSDF: ❑ ALVISO INDEPENDENT OIL—5002 Archer St.—Alviso,CA 95002 <br /> ❑ BAYSIDE OIL II, INC.—210 Encinal St.—Santa Cruz,CA 95060 <br /> ❑ ARTESIAN OIL RECOVERY INC.—2306 Magnolia St.—Oakland,CA 94067 <br /> ❑ DeMENNO/KERDOON—2000 N.Alameda St.—Compton,CA 90222 <br /> ❑ OCS—3256 N.Marks St.—Fresno,CA 93722 <br /> ❑. RAMOS ENVIRONMENTAL--1515 S.River Road—W.Sacramento,CA 95691 <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 /> I HEREBY CERTIFY THAT I HAVE NOT MIXED X <br /> THIS WASTE WITH ANY OTHER WASTE,AND THE <br /> TOTAL HALIDES ARE LESS THAN 1000 P.P.M. CUSTOMER SIGNATURE DATE <br /> I FURTHER AGREE TO ACCEPT THE ADDITIONAL X <br /> CHARGES FOR LEGAL DISPOSAL IF THIS WASTE - <br /> IS OVER 1000 P.P.M.TOTAL HALIDES PRINT NAME <br />