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ronmental Services • Bill of Lading/Invoice <br /> fnge86 95329 Z� For Service 73 i <br /> ,d) 538-0886/ Fax (209) 538-2498 800-760-0019 <br /> A# CAR000176537 , Date <br /> JOB LOCATION BILLING INFORMATION <br /> NAME '1 NAME CASH ❑ CHECK O <br /> ,ek # <br /> ADDRESS / ADDRESS CONTACT NAME <br /> CITY STATEi�, ZIP CO CITY STATE ZIP CO PO# <br /> � xyx <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 i•• <br /> Waste,Liquid i <br /> Non-RCRA Hazardous Waste Liquid CA 221 Gal -- "---- I <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 a <br /> Waste Flammable Liquid Paint CA 331 Gal <br /> Other: <br /> ✓: C. <br /> Other. ,— - <br /> Other: <br /> Other: <br /> Other. <br /> Tax <br /> TEST PASS FAH.❑ PPM Test <br /> U Collection Station U Agriculture Source A&S Environmental Services as the transporter of your TOTAL <br /> U Government Source U Industrial Source Hazardous waste may use another licensed transporter to CHARGES ✓ <br /> arine Source I haul your waste to a designated facility. <br /> DESIGNATED TSDF: U EVERGREEN ENVIRONMENTAL• 80 Smith Avenue•Newmark,CA•CAD982413262•(800)972-5284 <br /> fXBAMOS ENVIRONMENTAL• 151S.River Road•W Sacramento,CA 95691•CAD044003556•(916)371-5747 <br /> U RIVERBANK OIL TRANSFER• 5300 Claus Road•Riverbank,CA 95367•CAL000190816•(209)863-8181 <br /> U ALTERNATE FACILITY <br /> U ALTERNATE FACILITY <br /> U ALTERNATE FACILITY <br /> is to certify that the above named articles are properly classified,described,pack- A service charge of 1 1/2%per month shall he charged on all past due accounts. Collections <br /> marked and labeled,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 /> ticaregularions of the Department of Transportation. I HEREBY CERTIFY THAT 1 HAVE NOT MIXED THIS WASTE WITH ANY OTHER <br /> r / WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.;AND THAT <br /> `� THE WASTE DOES NOT CONTAIN ANY PCB'S. <br /> ,.rCI�r7[JRE GENERATOR'S SIGNATURE AMOUNT DUE IN 30 DAYS <br />