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SERVICE ORDER <br /> No. N 294970 <br /> ASBURY ENVIRONMENTAL SERVICES <br /> 2100 NORTH A MEDA STREET :ICOMPTON, CALIFORNIA 90222 ❑ (310) 886-3400 <br /> SAN DIEGO OFF CE NORTHERN OFFICE <br /> 1-800-748-574 EPA NO.CAD028277036 1-800-727-2879 <br /> 1-800-933-9194 <br /> DATE ONE TIME PICK UP ❑ YES or ❑ NO <br /> CUSTOMER RESIDENT ❑ YES or ❑ NO <br /> BILLING ADDRESS CONTRACT CUSTOMER ❑ YES or ❑ NO <br /> PHONE CONTACT ACCOUNT NUMBER <br /> CUSTOMER EPA# AMOUNT <br /> JOB SITE ADDRESS CHECK NUMBER <br /> P.O. NUMBER <br /> CROSS STREETS CASH RECEIVED <br /> (AMOUN-0 <br /> .Q <br /> NOTES: COMMODITY <br /> HALIDES P.P.M. <br /> ❑COMBUSTIBLE LIQUID, N.O.S., <br /> (Used Oil/Contaminated Petroleum P oducts), NA1993, PGIII <br /> ❑RQ, ENVIRONMENTALLY HAZARDO S SUBSTANCES, LIQUID, <br /> NOS, (Ethylene Glycol & Water), 9, N3082, PGIII NEXT SERVICE DATE <br /> ❑ U.S. DOT DESCRIPTION: DRUMS <br /> MANIFEST NO. NO. OF GALLONS <br /> DRIVER TRUCK NO. &RT <br /> DESIGNATED TSDF: ❑ ALVISO I DEPENDENT OIL- 5002 Archer St. -Alviso, CA 95002 <br /> ❑ BAYSIDE IL Il, INC. - 210 Encinal St. - Santa Cruz, CA 95060 <br /> ❑ BC STOC ING - 7300 Chevron Way - Dixon, CA 95620 <br /> ❑ DeMENN /KERDOON - 2000 N. Alameda St. - Compton, CA 90222 <br /> ❑ OCS - 32q6 N. Marks St. - Fresno, CA 93722 <br /> ❑ RAMOSE VIRONMENTAL- 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 N T MIXED /�y <br /> THIS WASTE WITH ANY OTHER WA TE,AND THE CUSTOMER SIGNATURE DATE <br /> t TOTAL HALIDES ARE LESS THAN 1 00 P.P.M. <br /> I FURTHER AGREE TO ACCEPT TH ADDITIONAL X <br /> CHARGES FOR LEGAL DISPOSAL IF THIS WASTE <br /> IS OVER 1000 P.P.M.TOTAL HALIDE PRINT NAME <br />