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ronmental Services • 0 Bill of Lading/Invoice <br /> .)x 186 w r- "' '' <br /> For Service J�' �`:3 <br /> ,range, CA 95329 t j057 <br /> 09) 538-0886 / Fax (209) 538-2498 800-760-0019 II <br /> EPA# CAR000176537 Date — a/0 7 <br /> JOB LOCATION BILLING INFORMATION <br /> NAM„ ,.•^' NAME CASH U CHECK U <br /> Le 4 # <br /> ADDRESS ADDRESS CONTACT NAME <br /> �� C i u✓ ,, 12 <br /> CITY �_ STATE ZIP CO CITY STATE ZIP CO PO# <br /> r,f <br /> •i , <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 /> � ! <br /> Used oil,Non-RCRA Hazardous Waste,Liquid CA 221 Gal -"-` <br /> w <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: <br /> Tax <br /> TEST PASS FAIL U PPM Test <br /> 't�(Colleclion Station U Agriculture Source A&S Environmental Services as the transporter of your TOTAL F"37 <br /> Government Source U Industrial Source Hazardous waste may use another licensed transporter to CHARGES <br /> U Marine Source haul your waste to a designated facility. <br /> DESIGNATED TSDF: U EVERGREEN ENVIRONMENTAL,• 80 Smith Avenue•Newmark,CA•CAD982413262•(800)972-5284 <br /> ,"MOS ENVIRONMENTAL• 151S.River Road•W.Sacramento,CA 95691•CAD044003556•(916)371-5747 <br /> U RIVERBANK OIL TRANSFER• 5300 Claus Road•Riverbank,CA 95367•CALD00190816•(209)863-8181 <br /> U ALTERNATE FACILITY <br /> U ALTERNATE FACILITY <br /> U ALTERNATE FACILITY <br /> This is to certify that the above named articles are properly classified described,pack- A service charge of 1 12%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 applicabl re egola[ions of[he 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 CO{N'T�W ANY S. <br /> DRI R SIGNS J RE GENERATOWTS G ATURE ///��' AMOUNT DUE IN 30 DAYS <br />