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II. <br /> _ -_ -- - SERVICE ORDER <br /> Il,. <br /> No. N 292923 r' <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 2100 NORTH ALAMEDA STREET o 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 /> r <br /> DATE IU' -i �.• - ONE TIME PICK UP ❑ YES or B-NO-" <br /> CUSTOMER RESIDENT ❑ YES or 6-NOS_. <br /> BILLING ADDRESS CONTRACT CUSTOMER YES or O NO <br /> PhfNE i.�:J 'i/L}.`i- t/"_`-+� 7 CONTACT F _ - ACCOUNT NUMBER <br /> tCUSTPMER EPA N AMOUNT I <br /> JOB SITE ADDRESS ifl�/ �- i.: `' > 5..��- �` CHECK NUMBERr1;j�e <br /> P.O.NUMBER _ <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: , _COMMODITY 7 :L.✓ -' <br /> HALIDES P.P.M. <br /> •O'EOMBUSTIBLE 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. �-+� =+�I 1 °-`� NO.OF GALLONS <br /> DRIVER J TRUCK NO.&RT <br /> - DESIGNATED TSDF: ALVISO INDEPENDENT OIL-6002 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 /> ❑ DeMENNOXERDOON-2000 N. Alameda St. -Compton, CA 90222 <br /> _ ,❑y OCS-3256 N. Marks St. -Fresno, CA 93722 <br /> �1 RAMOS ENVIRONMENTAL- 1515 S. River Road-W. Sacramento, CA 95691 <br /> This Is to certffy that the above named articles pro properly classified, described, packaged, <br /> marked and labeled,and are in properaondilign for transportation,according to the applicable <br /> regulations of the Department of Traltsportaffon. <br /> I HEREBY CERTIFY THAT I HAVE NOT MIXEDX rr s ,,,+^'- - 171 <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 r! j <br /> X <br /> CHARGES FOR LEGAL DISPOSAL IF THIS WASTE <br /> IS OVER 1000 P.P.M. TOTAL HALIDES - PRINT NAME/ <br />