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, 1 <br /> A&SEnvironmental Services Bill of Lading/invoice <br /> P.O. Box 186 For Service <br /> LaGrange, CA 95329 <br /> (209) 538`0886/ Fax (209) 538-2498 800-760-0019 <br /> EPA# CAR000176537 Date <br /> JOB LOCATION BILLING INFORMATION <br /> NAME i' / I NAME CASH LJ CHECK❑ <br /> Lam._y'� _r•-r`j f Ef 'liref # <br /> ADDRESs;.& fr �y ADDRESS CONTACT NAME <br /> CI 9TATF ZIP .CO CITY STATE ZIP CO P08 <br /> PHONE.NO.. 7 --, PHONE NO. PROFILE NO. C"V$TO R EPA.ID.NO _. <br /> PRODUCT WASTE MANIFEST QUANTI'l Y UNITS PRICE AMOUNT . <br /> CODE NUMBER (For Time Of Service Only) <br /> _ e' r <br /> Used oil,Non-RCRA Hazardous Waste,Liquid CA 22.f _ c� ,1 Gala. ""� <br /> Used Automotive Antifreeze,Non-RCRA Hazardous CA 134 Gal <br /> Waste,Liquid <br /> Non-RCRA Hazardous Waste Liquid CA 221 Gal <br /> Used Oil&Water <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA 223 Gal <br /> Empty Drum Delivery Drum <br /> Empty Drum Pick Up Drum <br /> Drained Used Oil Filters Drum <br /> Labor Hours <br /> Waste Flammable Liquid Gas CA 133. Gal <br /> Non-RCRA Hazardous Waste Solid CA 352 <br /> Each <br /> Waste Tires <br /> Waste Flammable Liquid Paint CA 331 <br /> Other: <br /> Other' <br /> Other: <br /> Other: <br /> UPAI <br /> Other: <br /> Tax <br /> TEST P4SS,2FAIL El PPM Test <br /> Collection Station ❑Agriculture Sou�(e A&S Environmental Services as the transporter of your TOTAL <br /> C3 Government source ❑Industrial Soyfeg Hazardous waste may use another licensed transporter to CHARGES <br /> ❑Marine Source K� haul your waste to a designated facility. - <br /> DESIGNATED TSDF: ❑EVERGREEN ENVIRONMENTAL• 80 Smith Avenue•Newmark,CA•CAD982413262 (800)972-5284 <br /> U RAMOS ENVIRONMENTAL• 1515.River Road-W.Sacramento,CA 95691•CAD044003556•(916)371-5747 <br /> ❑RIVERBANK OIL TRANSFER• 5300 Claus Road•Riverbank,CA 95367•CALOOO190816•(209)863-8181 <br /> ,'BEST ENVIRONMENTAL• 2430 Almond Drive•Silver Springs,NV 89429•NVD982358483•(775)577-9001 <br /> ❑ALTERNATE FACILITY <br /> ❑ALTERNATE FACILITY <br /> -- -This-is to certify that-the-above named articles are-properly classified,-described,-pack--A.seryicesharge of l l/2%.per month shal(be charged on allpast due accounts. Collections <br /> aged,marked And labeled,and arcin proper con -ion or ranspo a ion,ace r i luding-attomcyWees,will-be-added-tapast due$eoounts-placed-&r-GG1lactionsT— <br /> the applicable regulations •the-Department of'T�•atisportation I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY OTHER <br /> f ry <br /> WASTE,THATTHETOTAL HALIDES ARE LESS THAN 1000P.P.M.;ANDTHATTHE <br /> WASTE DOES NOT ON•AIN.ANY'PCB;S. <br /> . -- -� <br /> DRIVER SIGNATURE GENE TO 'MIQNATURE AMOUNT DUE IN 30 DAYS <br />