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A&S Environmental Services '' • Biu of Lading/Invoice <br /> P.O. Box 186 ILI <br /> LaGrange, CA 95329 For Service 8 2 2 <br /> (209) 538-0886 / Fax (209) 538-2498 800-760-0019 <br /> EPA# CAR000176537 Date /l' vl <br /> JOB LOCATION BILLING INFORMATION .�D 7 <br /> NAML_,_. NAME CASH❑ CHECK❑ <br /> ADDRESS L ADDRESS CONTACT NAME <br /> �i f <br /> CITY STATE ZIP q 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 y ��. Gal <br /> l✓G <br /> ,^?vz� <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;'n-'/ <br /> Tax <br /> TEST PASS FAIL❑ PPM Test <br /> �.'0:• ollection 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 /> arine Source haul your waste to a designated facility. CHARGES -r <br /> DESIGNATED TSDF: ❑EVERGREEN ENVIRONMENTAL• 80 Smith Avenue•Newmark,CA•CAD982413262•(800)972- <br /> ORAMOS ENVIRONMENTAL• 151S.River Road•W.Sacramento,CA 95691•CAD044003556•(9 )37 -5747 <br /> �❑RIVERBANK OIL TRANSFER• 5300 Claus Road•Riverbank,CA 95367•CALOD0190816•(209) 63,-8181 <br /> ❑ALTERNATE FACILITY / i <br /> ❑ALTERNATE FACILITY <br /> ❑ALTERNATE FACILITY / <br /> Jr! 6r1�P!nBR1PRdBOOga6w <br /> This is to certify that the above named articles are property classified described,pack- A service charge of 1 1/2%per month shall be charged on all past due accounts. Collections <br /> aged,marked and Ja4eled,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'iegulations 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 /> y `^ n <br /> DRIVER SIGNATURE. / �p GENE � TOR'S SIGNATURE AMOUNT DUE IN 30 DAYS <br />