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SERVICE ORDER <br /> No. N 298772 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 2100 NORTH ALAMEDA STREET ❑ 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 <br /> CUSTOMER I-N' 4 ]T•� - � - RESIDENT ❑ YES or 0.N6 <br /> BILLING ADDRESS i CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PHONE_`)'�)�r f;t ' ' 1.2 CONTACT ACCOUNT NUMBER <br /> CUSTOMER EPA# I rr"L f% ii r- J �::7 AMOUNT ~- <br /> JOB SITE ADDRESS P"" { kr r ,r -' CHECK NUMBER <br /> P.O. NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (A WNT) <br /> NOTES: COMMODITY <br /> HALIDES P.P.M. <br /> ❑'COMBUSTIBLE 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 - r NEXT SERVICE DATE <br /> ❑ U.S. DOT DESCRIPTION: 1 /1VYf/ DRUMS <br /> MANIFEST N0. '`�' �� -� % NO.OF GALLONS <br /> DRIVER 1 .„ 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 /> ❑ DeMENNO/KERDOON - 2000 N. Alameda St. - Compton, CA 90222 <br /> _ ❑ OCS- 3256 N. Marks St. -Fresno, CA 93722 <br /> Q RAMOS ENVIRONMENTAL- 1515 S. raver Road-W. Sacramento, CA 95691 / <br /> r <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 Department of Transportation. <br /> I HEREBY CERTIFY THAT I HAVE NOT MIXED X <br /> THIS WASTE WITH ANY OTHER WASTE,AND THE <br /> TOTALINALIDES ARE LESS THAN 1000 P.P.M. %, CUSTOMER SIGNATURE J DATE <br /> %FURTHER AGREE TO ACCEPT THE ADDITIONAL vV <br /> CHARGES FOR LEGAL DISPOSAL IF THIS WASTE A /447 <br /> `� <br /> "f /••''" PRINT TtAW <br /> IS OVER 1000 P.P.M.TOTAL HALIDES , -- <br />