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A&.�- nviro.nmental Services Bill of Lading/Invoice <br /> P.O. Box 186 : . <br /> LaGrange, CA 95329 For Service . <br /> (209) 538-0886/ Fax(209) 538-2498 800-760-0019 <br /> EPA# CAR000176537 Date {% f <br /> JOB LOCATION BILLING INFORMATION <br /> 11 A� --yyANAME CASH 0 CHECK 0 <br /> M <br /> ADDRESS ADDRESS CONTACT NAME <br /> CIT1CV , f S2'A,Tr;E ZIP - CO CITY STATE ZIP CO PO# <br /> PHONE NO. PHONE NO. PROFILE NO.• - s5T0 j A ID I� <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 42}'{}j <br /> 1 Gel <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&Wate,Non-RCRA Hazardous Waste Liquid CA 223 Gal _ <br /> Empty Drum Delivery Drum <br /> Empty Drum Pick Up Drum <br /> Drained Used Oil Fillers Drum "? — 71:1 <br /> Labor Hours <br /> Waste Flammable Liquid Gas CA 133 Gal <br /> Non-RCRA Hazardous Waste Solid V CA 352 1 Cj,)'g,;r94.;y,'. , l st t J i l c'(,C)7—' <br /> Waste <br /> ,CY"— <br /> Waste Tires Each <br /> Waste Flammable Liquid Paint CA 331 <br /> Other: <br /> Other: <br /> Other t <br /> Other: <br /> Other: <br /> ......-.... . t•IFQt iu MR 7 <br /> TEST PASS-U` FAIL 0 PPM Test <br /> O Collection Station 0 Agriculture Source A&S Environmental Services as the-transporter of your TOTAL N <br /> Hazardous waste may use another licensetrans <br /> Cl Government Source E3 Industrial Source Y d transporter to p � <br /> CHARGES -"_3 <br /> 0 Marine Source haul your Waste to a designated facility, J <br /> DESIGNATED TSDF: 0 EVERGREEN ENVIRONMENTAL• 80 Smith Avenue•Newmark,CA•CAD982413262•(800)972-5284 <br /> 0 RAMOS ENVIRONMENTAL•. 151 S.River Road•W.Sacramento,CA 95691•CAD044003556•(916)371-5747 <br /> 0 RIVERBANK OILTRANSF'T-r • 5300 Claus Road•Riverbank,CA 95367•CAL000190816•(209)863-8181 <br /> 0 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]112%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,inqluding attomey's fees,will be.added to past due accounts placed for collections. <br /> the applicable regulgtions of th Department of Transportation. 1 HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY OTHER <br /> ll r <br /> WASTE,THATTHETOTAL kkdDESARE LESS TI4AN1000P.P.M.;AND THATTHE <br /> rr — WASTE*DOES NOT CONTA*.-XNY PCB'S. <br /> DRIVE SIGNATURE GENERATOR'S SIGNATURE AMOUNT DUE 1N 30 DAYS <br />