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A&S Environmental Services <br /> Bill-of Lading/Invoice <br /> P.O.. Box 186 <br /> LaGrange, CA 95329 For Service <br /> 2.115 <br /> (209) 538-08861 Fax (209) 538-2498' 800-760-0019 <br /> EPA# CAR00017.6537 <br /> Date <br /> JOB LOCA ION BILLING INFORMATION <br /> NAME I // J NAME CASH❑ CHECK❑ <br /> ADDRES ; , i ADDRESS CONTACT NAME <br /> CITY`'" f STATE. r ZIP .. CO CITY STATE ZIP CO . r0# <br /> N'..,1.. PHONE N0. PROFILE NO. ZIMER� <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 0 <br /> Used Automotive Antifreeze,N6n-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 Flaminalile Liquid Gas CA 133 Gal <br /> Non-RCRA Hazardous Waste Solid CA 352 ' <br /> Wasfe.Tires 1► k I C_ ~\ <br /> Was(enanarable Liquid Paint CA 331 al <br /> Other: • <br /> Other " J <br /> Other. <br /> Other: <br /> Other:' <br /> Tax <br /> TEST PASS,LL FAIL 0 PPM Test <br /> 13-Collection Station ❑Agriculture Source A&S Environmental Services as the transporter of your TOTAL _ <br /> ❑Government Source 0 Industrial Source Hazardous waste may use another licensed transporter to CHARGES <br /> 0 Marine Source haul your waste to a designated facility. <br /> I1 <br /> DESIGNATED TSDF: l <br /> ❑EVERGREEN EI NIRONMI;NTAL• 80 Smith Avenue•Newmark,CA•CAD982413262•(80D)972-5284 <br /> D RAMOS ENVIRONMENTAL• 151 S.River Road•W.Sacramento,CA 95691•CAD044003556•(916)371-5747 <br /> 0 RIVERBANK OIL TRANSFER• 5300 Claus Road•Riverbank,CA 95367•CAL000190816•(209)863-8181 <br /> O-BEST ENVIRONMENTAL• 2430 Almond Drive•Silver Springs,NV 89429•NVD982358483•(775)577-9001 <br /> 0 ALTERNATE FACILITY <br /> 0 ALTERNATE FACILITY <br /> This is to certify that the above named articles are properly classified,described,pack A service charge of 1 M%permonth shall be charged on all past due accounts. Collections <br /> aged,marked and In le 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 reg i to s of the Department ofTransportatign. I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY OTHER ; <br /> r :WASTE,THATTI E TOTAL HALIDES ARE LESS THAN 1000P-P.M.;ANDTHATTHE <br /> WWA TE Db&S NO CONTAIN ANY PTB'$. <br /> DRIVER SIr NATURE GENE, TOWS SIC3 ATGRE 1 AMOUNT DUE IN 30 DAYS ' <br />