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A&S Envkorimental Services • • Bill of Lading/Invoice <br /> P.O, Box 186 For Service <br /> LaGrange, CA 95329 9 h 03 <br /> (209) 538-0886 / Fax (209) 538-2498 800-760-0019 C <br /> EPA# CAR000176537 Date <br /> JOB LOCATION BILLING INFORMATION <br /> NAS NAME CASH LJ CHECK ❑ <br /> j//'F1 4-9 <br /> ADDR��Sj ,b T4�r t1? ADDRESS CONTACT NAME <br /> CITY,// �jtt''J ' ' STATE ZIP CO CITY STATE ZIP CO PO# <br /> r <br /> PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> PRODUCT / 'd 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 /> 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 <br /> Drum <br /> Drained Used Oil Filters Drum �Q <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 El FAIL C] PPM Test <br /> 0 Collection Station ❑Agriculture Source A&S Environmental Services as the transporter of your TOTAL <br /> ❑Government Source ❑Industrial Source Hazardous waste may use another licensed transporter to . <br /> ❑Marine Source haul your waste to a designated facility. CHARGES <br /> e3 6, -';�b <br /> DESIGNATED TSDF: ❑EVERGREEN ENVIRONMENTAL• 80 Smith Avenue•Newmark,CA•CAD982413262•(800)972-5284 <br /> ❑RAMOS ENVIRONMENTAL• 151S.River Road•W.Sacramento.CA 95691•CAD044003556•(916)371-5747 <br /> ❑RIVERBANK OIL TRANSFER• 5300 Claus Road•Riverbank,CA 95367•CAL000190WL (209)803--8.1' 1 <br /> ❑ALTERNATE FACILITY <br /> O ALTERNATE FACILITY I <br /> ❑ALTERNATE FACILITY <br /> This is to certify that the above named articles are properly classified,described,pack- A service charge of I U22%per month shall be charge n st i�j acc '7 Collections <br /> aged,mzrke4 I labeled,and are in proper condition for transportation,according to costs,including attorney's fees,will be added to ou pl ed if <br /> collections. <br /> the applica edegulations of the Department of Transportation. I HEREBY CERTIFY THAT I HAVE NOT MI D T o'A.S:>4'�TH-ANY OTHER <br /> WASTE.THAT THE a'OTAL HALW A LESS THAN 1000 P.P.M.;AND THAT <br /> THE WA TE DO Ht A PCB'S. <br /> Dl tlk SIGNATUIT tigNERATORt SI A RE AMOUNT DUE IN 30 DAYS <br /> r <br />