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A&S Environmental Services • Bill of LadinWinvoice <br /> R& BoX 186 For Service 9443 <br /> LaGrange, CA 95329 <br /> (209) 538-0886 / Fax (209) 538-2498 800-760-0019 �3 <br /> EPA# CAR000176537p wpq Date <br /> JOB LOCATION BILLING INFORMATION `" v <br /> NA NAME CASH O CHECK ❑ <br /> ADDgE55 / ` ? ADDRESS CONTACT NAME <br /> CIT}• STATE _ ZIP CO CITY STATE ZIP CO PO# <br /> f j: L!5 `j �t1 Z <br /> PHONE NO. ,`, PHONE NO. PROFILE NO. CUSTOMER 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 .} _s Gal /fr <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 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 /> TEST PASS-W FAIL El 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.lA <br /> Marine Source haul your waste to a designated facility, � <br /> DESIGNATED TSDF: ❑EVERGREEN ENVIRONMENTAL• 80 Smith Avenue•Newmark,CA•CAD982413262•.(800)972-5 <br /> ❑RIVERBANKIOL TRANSFER• 5300 ClausNMENTAL- 15 1 S.River RR ad Riv cbanknCA 95367to,CA 69CAL0 0/9080355 0 1 6)- I <br /> ALTERNATE FACILITY ' .?,:=" z.- uy191 0 ,- <br /> 42 <br /> ❑ALTERNATE FACILITY �l <br /> ❑ALTERNATE FACILITY <br /> This is to certify that the above named articles are properly classified.described,pack- A service charge of 11/2'9 per month shell be r ar®edon•all past ue accounts. Collections <br /> aged,marked and laded.,and are in Proper condition for transportation,according to costs,including attorney's fees,will be added to past due accounts placed for collections. <br /> the applicable r5eli(ations of the Dedartment of Transportation. I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY OTHER <br /> i WASTE.THAT THE TOTAL HALIDES ARE LESS THAN 100 P.P.M.;AND THAT <br /> Ar <br /> THE WASTE DOES NOT CONTAIN ANY PCB'S. <br /> r <br /> DOV SIGNA `GENERATOR'S SIGNATURE AMOUNT DUE IN 30 DAYu <br />