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_—_— SERVICE ORDER <br /> mow <br /> No. N 308684 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 2100 NORTH ALAMEDA STREET ❑ COMPTON, CALIFORNIA 90222 d (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 Y_ _ t''. ONE TIME PICK UP ❑ YES or -NO <br /> CUSTOMER Ze RESIDENT ❑ YES or�7-NO <br /> BILLING ADDRESS 1���� � ,j 7 CONTRACT CUSTOMER ❑ YES or bTNO <br /> PHOfiI � �^3- �� 3 CONTACT ,CEJ ACCOUNT NUMBER <br /> CUSTOMER EPA N � G'n Z-0 AMOUNT <br /> JOB SITE ADDRESS CHECK NUMBER <br /> P.O.NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUNT) <br /> NOTES: COMMODITY ��'�.'� r' <br /> HALIDES i`( � 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 P III NEXT SERVICE DATE <br /> U.S.DOT DESCRIPTION: lNi� �i•>t'�"r9 n" DRUMS <br /> MANIFEST NO. (1�l�' l NO.OF GALLONS AGO <br /> DRIVER !^ _Ol'F�J 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 /> MOS ENVIRONMENTAL- 1515 S. River Road-W. Sacramento, CA 95691 <br /> This is to certify that the above na ed articles are property classified, described, packaged, <br /> marked and labeled,and arein proper conjition for transportation,according to the applicable <br /> regulations of the Depa nt clIrransporfation. <br /> I 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. USTOMER SIGNATURE DATE <br /> I FURTHER AGREE TO ACCEPT THE ADDITIONAL X Ao s <br /> . CHARGES FOR LEGAL DISPOSAL IF THIS WASTE- -: <br /> IS OVER 1000 P.P.M.TOTAL HALIDESya r. PRINT NAME <br />