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A&S Environmental Services i • Biu of Lading/Invoice <br /> P.O. Box 186 <br /> LaGrange, CA 95329 For Service ;, ; <br /> (209) 538-0886 / Fax (209) 538-2498 800-760-0019 <br /> EPA# CAR000176537 ur ) p G <br /> JOB LOCATION BILLING INFORMATION <br /> ry f? 9 e NAME CASH O CHECK El <br /> ADDRES `' ADDRESS CONTACT NAME <br /> Jt 4' 42 <br /> C12 STATE ZIP CO CITY STATE ZIP CO PO# <br /> PHONE NO._ PHONE NO. PROFILE NO. gCUSTOMER EPA ID NO. <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 _ „-2 `n Gal <br /> Used Automotive Antifreeze,Non-RCRA Hazardous CA 134 Gal <br /> Waste,Liquid <br /> Non-RCRA Hazardous Waste Liquid CA 221 Gal <br /> Used Oil&Water <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA 223 Gal <br /> Empty Drum Delivery t 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: <br /> Other: <br /> Other: <br /> Other: <br /> Tax <br /> TESTPASS A FAIL El PPM Test <br /> Collection Station ❑Agriculture Source A&S ronmental Services as the transporter of your TOTAL '`i' <br /> Government Source ❑Industrial Source Haza useaste may use another licensed transporter to CHARGES ' ^� <br /> ❑Marine Source ban y I 3s4e to a-desig faci'ty. <br /> DESIGNATED TSDF: ❑EVERGREEN ENVIRONMENTAL• 80 Smith Avenue•Newmark,CA•CAD982413262•(800)972-5 js- <br /> XRAMOS ENVIRONMENTAL• 151 S.River Road•W.Sacramento,CA 95691•CAD044003556•(9 )err' 5 �71� <br /> ❑_RIVERBANK OIL TRANSFER• 5300 Claus Road•Riverbank,CA 95367•CAL000190816•(209) 3.818��1�� t <br /> ❑ALTERNATE FACILITY T f I'i ,/ <br /> 1 <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%per month shall be charged—wall past due accounts. Collections <br /> aged,marked and labeled,and are in proper condition for transportation,accordingd costs,including attorney's fees,will be added to pest due accounts placed for collections. <br /> the applicabJaeegol�tions of the D ;r�()ri. t of Transportation. I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY OTHER <br /> / WASTE.THAT TH TOTAL HALIDES ARE LESS THAN 1000 P.P.M.;AND THAT <br /> �. THEW OE5 7OT ONTAIN ANY PCB'S. <br /> RI ER SIGNA;L1IRE <br /> GE RATOR'S SIGNATURE AMOUNT DUE IN 30 DAYS <br />