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.._...,... ,.,.. ,..,. ,.. r .v..a.ne. .. <br /> rl <br /> - <br /> , <br /> SERVIC <br /> Y No: N 278593 <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 EPANO.CAD02e277036'' 1-800-727-2879 <br /> 800-933- 8 <br /> DATE ONE TIME PICKUP ❑ YES or NO .. <br /> (/r} <br /> CUSTOMER -s ''�r'i3 RESIDENT ❑ YES or ❑--NO <br /> BILLING ADDRESS t CONTRACT CUSTOMERCr ES or ❑ NO <br /> PHONE`•" '//&3- 1 `t' CONTACT ACCOUNT NUMBER <br /> CUSTOMER EPA N t- - / ' y' '�'�' "�L> AMOUNT <br /> JOB SITE ADDRESS tT f/� �- f�<^'`r''" I J.: . CHECK NUMBER <br /> ,���:...`F ,...� ., , `-r'3,..�c..'t✓i P.O. NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> fanourrtl <br /> -NOTES: - - COMMODITY G✓ <br /> HALIDES P.P.M. <br /> ('COMBUSTIBLE LIQUID,N.O.S. (USED OILS&MIXED OILS) <br /> NA 1993, PG 111 <br /> ❑ ETHYLENE GLYCOL NON-RCRA <br /> HAZARDOUS WASTE LIQUID NO PLACARD REQUIRED NEM SERVICE DATE <br /> ❑ U.S.DOT DESCRIPTION: DRUMS <br /> 1-k-1 <br /> MANIFESTN0. J/z G- -" ''� NO.OF GALLONS l� <br /> DRIVER -� :, TRUCK NO.&RT - <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 /> ❑ BC STOCKING -7300 Chevron Way-Dixon, CA 95620 <br /> ❑ .DeMENNOIKERDOON-2000 N. Alameda St. -Compton, CA 90222 <br /> Q..-OCS- 3256 N. Marks SL -Fresno, CA 93722 - 1 <br /> 13 RAMOS ENVIRONMENTAL- 1515 S. River Road-W. Sacramento, CA 95691 J <br /> This is to certify that the above named articles are property classified, described, packaged, <br /> marked and labeled,and are In proper,condition for transportation,according to the applicable <br /> regulations of the Departmentpf Transportation. <br /> I HEREBY CERTIFY THAT I HAVE NOT MIXED X <br /> THIS WASTE WITH ANY OTHER WASTE,AND THE CUSTOMER SIGNATURE DATE <br /> TOTAL HALIDES ARE LESS THAN 1000 P.P.M. <br /> I FURTHER AGREE TO ACCEPT THE ADDITIONAL X <br /> CHARGES FOR LEGAL DISPOSAL IF THIS WASTE - / PRINTNAME <br /> IS OVER 1000 P.P.M.TOTAL HALIDES <br />