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A&S Environmental Services • I • Bill of LadinWInvoice <br /> P.O. Box 186 For Service r 5 ry <br /> LaGrange, CA 95329 �J .- <br /> (209) 538-0886 / Fax (209) 538-2498 <br /> 800-Iso-0019 =>;' 2, ; y <br /> EPA# CAR000176537 Dat,<e2 42 eF- <br /> JOB LOCATION BILLING INFORMATION <br /> N NAME CASH❑ CHECK El <br /> r' '-)k # <br /> ADDRESS ADDRESS CONTACT NAME <br /> CITY F STATE ZIP CO CITY STATE ZIP CO Po# <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 Gal <br /> Used Automotive Antifreeze,Non-RCRA Hazardous CA 134 Gal <br /> Waste,Liquid <br /> Nan-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 GH <br /> Other: <br /> Other: <br /> Other: <br /> Other: <br /> SO <br /> Other: ------ <br /> cr t, <br /> �, / � /` ' '/;!C P - -- <br /> Tax <br /> TEST PASS FAIT,❑ PPM Test <br /> =Govemment <br /> ❑AgricultureSource A&S Environmental Services as the transporter of your TOTAL❑Industrial Source Hazardous waste may use another licensed transporter toCHARGES haul your waste to a designated facility. <br /> DESIGNATED TSDF: ❑EVERGREEN ENVIRONMENTAL- 80 Smith Avenue-Newmark,CA-CAD992413262-(800)972-5284 <br /> ARAMOS ENVIRONMENTAL- 151S.River Road-W.Sacramento,CA 95691-CAD044003556-(916)371-5747 <br /> O RIVERBANK OIL TRANSFER- 5300 Claus Road-Riverbank,CA 95367-CAL000190816-(209)863-8181 <br /> ❑ALTERNATE FACILITY <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 1 112%per month shall be charged on all past due accounts. Collections <br /> aged,marked and labeled,and are in proper condition for transportation,according to costs,including anomey's fees,will be added to past due accounts placed for collections. <br /> the applicable regulations of the,Department of Transportation. I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY OTHER <br /> WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.:AND THAT <br /> THE WASTE DOES NOT CONTAIN ANY PCB'S. <br /> RIVER SIGNATURE �` GENERATOR'S SIGNATURE AMOUNT DUE IN 30 DAYS <br />