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onmental,5,ervices ' ' Bill of Lading/Invoice <br /> 186/r For Service 5 <br /> Ige, CA 95329 <br /> 538-0886/ Fax (209) 538-2498 800-760-0019 , <br /> A CAR000176537 Date <br /> /B LOCATION BILLING INFORMATION <br /> NAMPI," <br /> . NAME CASH p CHECK <br /> t®/�/C .�1(rCL �.�C/117J/ ('r, t-l <br /> } h' uV •Y .rte•. I u.. . <br /> ADDRESS <br /> Gy { '/ ADDRESS CON,TACT NAME' _ <br /> zwxj <br /> CITY STATE <br /> ZIP CO CITY ,.,,+ F ' STATE ZIP ,: ,./CO PO# <br /> AV <br /> PHONE NO. d PHONE NO. sq` �ROFILE�Np, , '•.I il 7$TOMER EBN ID NO- <br /> Si ..J�i� ) .. .rte,.. . .r.� ` <br /> PRODUCT WASTE MANIFE .rr '7"CITY•" 'UNITS' + PRICE'- '` AMOUNT <br /> i r br Time Of Service'( 1 <br /> CODE NUMBER.. — . ::s _. (F 9 <br /> Gi•.� <br /> Used oil,Non-RCRA Haza434ris',1Vaste,Liquid Gal <br /> 'Used Automotive Antifreeze, +Ion-RCRA Hazardous CA 134 Gal <br /> Waste,Liquid r <br /> ' Non-RCRA Hazardous Waste Liquid CA 221 Gal _ <br /> Used Oil&Water - <br /> , rC <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA 223 •~ Gal <br /> r <br /> Empty Drum Delivery Drum <br /> ,Empty Drum Pick Up <br /> 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 tial <br /> Waste Tires - <br /> Waste Flammable Liquid Paint CA 331 Gal <br /> Other: <br /> Other: <br /> Other: — l] <br /> ':YJry aT[a�ilTbPN4^1HS-0gpyp <br /> Other: _ <br /> Other: '' t .•r"n.�3/^C <br /> TU <br /> TEST PASS FAIL❑ PNM Test <br /> ❑Collection Station ❑Agriculture Source A&S Environmental Services as the transporter of your TOTAL .- o Gr. <br /> ❑Government Source ❑Industrial Source Hazardous waste may use another licensed transporter to CHARGES (/ <br /> Marino source haul your waste to a designated facility. // <br /> DESIGNATED TSDF: ❑EVERGREEN ENVIRONMENTAL• 80 Smith Avenue•Newmark,CA•CAD982413262•(800)972-5284 ((j 3 1C,3 'oZ!� <br /> ❑RAMOS ENVIRONMENTAL• 151S.River Road•W.Sacramento,CA 95691•CAD044003556•(916)371-5747 <br /> ❑RIVERBANK OH.TRANSFER• 5300 Claus Road•Riverbank,CA 95367•C 190816•(209)863-8181 <br /> ,'WALTERNATEFACILITY li 4.1 D �dT� <�11 %r�d''CdlcW .F Air!//5-rJ <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 1/2%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 attorney'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 /> VER SiGNA GENERATOR'S SIGNATURE AMOUNT DUE IN 30 DAYS <br />