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SERVICE ORDER <br /> NO. N 286874 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 2100 NORTH ALAMEDA STREET o COMPTON, CALIFORNIA 90222 ❑ (310) 886-3400 <br /> SAN DIEGO OFFICE NORTHERN OFFICE <br /> 1-800-748-5744 EPA NO.CAD028277036 79 <br /> 1-800-933-2894 <br /> DATE !i?-;f I !/ ONE TIME PICK UP ❑ YES or NO <br /> /`� <br /> CUSTOMER 1/ + "� RESIDENT ❑ YES or ❑'N r" <br /> BILLING ADDRESS CONTRACT CUSTOMER S or ❑ NO <br /> PHONEf I �(a "J'sTll 4? CONTACT ACCOUNT NUMBER <br /> CUSTOMERTPAM <br /> {�f`ty vJx.3 jr=J '. ,1�'j'� AMOUNT <br /> � ,� <br /> A i <br /> JOB SITE ADDRESS f%1 `� r "�' '"' t`�� CHECK NUMBER r ' y <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMourrr) <br /> NOTES: COMMODITY <br /> HALIDES P.P.M. <br /> LeOMBUSTIBLE LIQUID, N.O.S., <br /> (Used Oil/Contaminated Petroleum Products), NA1993, PGIII <br /> ❑RQ, ENVIRONMENTALLY HAZARDOUS SUBSTANCES, LIQUID, <br /> NOS, (Ethylene Glycol&Water), 9, UN3082, PGIII NEXT SERVICE DATE <br /> ❑ U.S.DOT DESCRIPTION: DRUMS <br /> MANIFEST NO. f 6" . ._� NO.OF GALLONS <br /> DRIVER .�'' x'-^! <br /> TRUCK NO.&RT <br /> - -DESIGNATED TSDF: ❑- ALVISO INDEPENDENT OIL-6002 Archer St.-Alviso, CA 95002 <br /> ❑ BAYSIDE OIL 11, 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 /> ❑ vI�y�,��.a.S-3256 N. Marks St.-Fresno, CA 93722 <br /> JfA 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 /> HEREBY CERTIFY THAT I HAVE NOT MIXED - C' <br /> THIS WASTE WITH ANY OTHER WASTE,AND THE <br /> TOTAL HALIDES ARE LESS THAN1000P.P.M. CUSTOMER SIGNATURE DATE <br /> I FURTHER AGREE TO ACCEPT THE ADDITIONAL <br /> CHARGES FOR LEGAL DISPOSAL IF THIS WASTE - `' •' -jr ' f` <br /> IS OVER 1000 P.P.M.TOTAL HALIDES PRINT NAME ' <br />