Laserfiche WebLink
SRI! ERVICE <br /> V } � <br /> 2843 <br /> ASBURY ENMRONMENTAL SERVICES <br /> 2100 NORTH ALAMEDA STREET A 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 ! ONE TIME PICK UP ❑ YES or ❑ NO <br /> -217'CUSTOMER, d -� r r`-�•��� f�-�'U :RESIDENT ❑ YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> r <br /> PHONE CONTACT ACCOUNT NUMBER <br /> CUSTOMER EPA M �J/ Jam/ j� AMOUNT <br /> JOB SITE ADDRESS JIiic 6111(/�R-apWAY CHECK NUMBER <br /> 64 `-7 _7-� P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED �.tt34 <br /> NOTES: -. __.-. . - - - -- COMMODrw <br /> HALIDES P.P.M. <br /> EktOMBUSTIBLE LIQUID, N.O.S., <br /> 1Used Oil/Contaminated Petroleum Products), NA7993, PGIII <br /> ❑RQ, ENVIRONMENTALLY HAZARDOUS SUBSTANCES, LIQUID, <br /> NOS, (Ethylene Glycol &Water), 9,UN3082, PGIII NEM SERVICE DATE <br /> p-U.S.DOT DESCRIPTION: � n1 61/ DRUMS <br /> MANIFEST NO. �1T -i�iS` - NO.OF GALLONS L C1iq::SCJ <br /> DRIVERC &4 9 4 k1l T f66K NO.&RT , <br /> - DESIGNATED TSDF: WALVISO INDEPENDENT OIL-6002 Archer St.-Alviso, CA 95002 <br /> BAYSIDE OIL ll,INC.-210 Encinal St.-Santa Cruz, CA 95060 <br /> ❑ BC STOCKING-7300 Chevron Way- Dixon, CA 95620 <br /> ,t❑-DeMENNO/KERDOON- 2000 N. Alameda St.-Compton, CA 90222 <br /> L] CS-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 article's are property classified, described, packaged, <br /> marked and labeled and are In proper condition for transportation,according to the applicable_ <br /> regulations of the Department of Tri nspo4tion ---I <br /> 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 <br /> .-CHARGES FOR LEGAL DISPOSAL IF THIS WASTE <br /> PRINT NAME <br /> ',,4S OVER 1000 P.P.M.TOTAL HALIDES `-- - <br />