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SERVICE ORDER <br /> No. N 308049 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> " '2 00 ORTH ALAMEDA STREET ❑ COMPTON <br /> , 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 - ✓ C c ONE TIME PICK UP ❑ YES or NO <br /> CUSTOMER -5 TT^n '+ fJtr^ t- A, RESIDENT 0 YESor NO <br /> BILLING ADDRESS c9- /-r rlr e/ CONTRACT CUSTOMER El YES or O-NO <br /> PHON :�1) K/�i�' Zi PZ 3 CONTACT ACCOUNT NUMBER <br /> CUSTOMER EPA M AMOUNT <br /> JOB SITE ADDRESS CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY e <br /> HALIDES P.P.M. <br /> 0 COMBUSTIBLE LIQUID, N.O.S., <br /> (Used Oil/Contaminated Petroleum Products), NA1993, PGIII <br /> ❑RO, ENVIRONMENTALLY HAZARDOUS SUBSTANCES, LIQUID, <br /> NOS, (Ethylene Glycol &Water), 9, UN3082, PGIII NEXT SERVICE DATE <br /> 1f(U.S.DOT DESCRIPTION: DRUMS <br /> MANIFEST NO. NO.OF GALLONS <br /> DRIVER -/ ,�•"/'�r TRUCK NO.&RT <br /> _ _.DESIGNATED TSDF: ❑. ALVISO INDEPENDENT OIL-5002 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 /> ❑ DeMENNO/KERDOON- 2000 N. Alameda St. -Compton, CA 90222 <br /> ❑ OCS-3256 N. Marks St. - Fresno, CA 93722 <br /> „—'Q"'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 /> I HEREBY CERTIFY THAT I HAVE NOT MIXED X .ti _ —,+-1.-l`• / �'� <br /> THIS WASTE WITH ANY OTHER WASTE,AND THE -- <br /> TOTAL HALIDES ARE LESS THAN 1000 P.P.M. CUSTOMER SIGNATU DAT <br /> -I FURTHER AGREE TO ACCEPT THE ADDITIONAL - <br /> CHARGES FOR LEGALDISPOSALIFTHIS WASTE _. X / ', fJJ .P .' �•� <br /> IS OVER 1000 P.P.M:TOTAL HALIDES - - <br /> i <br />