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A&S Environmental Services • Bill of Lading/Invoice <br /> P.O. Box 186 <br /> LaGrange, CA 95329 For Service 40 02010 i3 <br /> (209) 538-0886 / Fax (209) 538-2498 800-760-0019 <br /> EPA# CAR000176537 Date <br /> JOB LOCATION BILLING INFORMATION <br /> 1 [, NAME CASH EI CHECK 0 <br /> d �$ k r!. . 9 r # <br /> ADDRESS ADDRESS CONTACT NAME <br /> % .�? '.L✓ �q <br /> CITYJF STATE ZIP CO CITY STATE ZIP CO PO -4 drt <br /> PHONE NO. PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> _y�el 'w� ( ) �.K� <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER (For Time Of Service Only) <br /> Used oil,Non-RCRA Hazardous Waste,Liquid CA 221 Gal <br /> e3<�c1L �.. Li 1 .�, <br /> Used Automotive Antifreeze,Non-RCRA Hazardous CA 134 Gal <br /> Waste,Liquid <br /> Non-RCRAHazardous Waste Liquid CA 221 Gal <br /> Used Oil&Water <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA 223 Gal <br /> Empty Drum Delivery Drum <br /> Empty Drum Pick Up Drum <br /> Drained Used Oil Filters Drum <br /> Labor Hours <br /> - Waste Flammable Liquid Gas CA 133 Gal <br /> Non-RCRA Hazardous Waste Solid CA 352 Gal <br /> Waste Tires <br /> Waste Flammable Liquid Paint CA 331 Gal <br /> Other: <br /> Other: y sZ— <br /> Other: 1, VIMr <br /> Other: V <br /> Other: <br /> Tax <br /> TEST PASS FAIL❑ PPM Test <br /> Collection Station ❑Agriculture Source A&S Environmental Services as the transporter of your TOTAL <br /> O Government Source ❑Industrial Source Hazardous waste may use another licensed transporter to CHARGES <br /> ❑Marine Source I haul your waste to a designated facility. <br /> DESIGNATED TSDF: ❑EVERGREEN ENVIRONMENTAL• 80 Smith Avenue•Newmark.CA•CAD982413262•(800)972-5284 <br /> 0 RAMOS ENVIRONMENTAL• 15 IS.River Road•W.Sacramento.CA 95691 •CAD044003556•(916)371-5747 <br /> ❑RIVERBANK OIL TRANSFER• 5300 Claus Road•Riverbank,CA 95367•CAL000190816•(209)863-8181 _ <br /> ALTERNATE FACILITY Vqiem g3 e,-, <br /> ❑ALTERNATE FACILITY <br /> ❑ALTERNATE FACILITY <br /> This is to certify that the above named articles are properly classified,described,pack- A service charge of 1 1/2'7r per month shall be charged on all past due accounts. Collections <br /> aged,markedlind.labeled,and are,krproper condition for transportation,according to costs,including attorney's fees,will be added to past due accounts placed for collections. <br /> the applicable regulations of the,D partment of Transportation. I HEREBY CERTIFY THAT 1 HAVE NOT MIXED THIS WASTE WITH ANY OTHER <br /> i' WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.:AND THAT <br /> - .J THE WASTE DOES NOT CONTAIN ANY PCB'S. <br /> i i 0 t7 <br /> D19VER SIGNA REr /i - GENERATOR'S SIGNATURE AMOUNT DUE IN 30 DAYS <br />