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Jun 1,6 09 11 : 42a Jeff Kindorf 2098207818 p. 2 <br /> A&S Environmental Services Bill of Lading/Invoice <br /> P.O. Box 186 For Service = <br /> LaGrange, CA 95329 800-760-0019 <br /> (209) 538-0886 I Fax (209) 538-2498 <br /> EPA# CAR000176537 Date <br /> JOB LOCATION BILLING INFORMATION <br /> NAME CASH❑ CHECK❑ <br /> NAME # <br /> ADDRESS ADDRESS CONTACT NAME <br /> CITY STATE ZIP CO CITY STATE ZIP CO PO# <br /> PHONE NO. . PHONE NO. PROFILE NO. CUSTOMER EPA ID NO. <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER (For Time OI'Service Only) <br /> Used oil.Non-RCRA Hazardous Waste,Liquid CA 221 Gal <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 /> Drum <br /> Empty Drum Delivery <br /> Drum <br /> Empty Drum Pick Up <br /> Drained Used Oil Filters Drum <br /> Hours <br /> Labor <br /> Waste Flammable Liquid Gas CA 133 Gal <br /> Non-RCRA Hazardous Waste Solid CA 352 Gal <br /> Alaste Tires <br /> Waste Flammable Liquid Paint CA 331 Gal <br /> Other: <br /> Other: <br /> Other: <br /> Other: <br /> Other: <br /> Tax <br /> TEST PASS O, FAIL J PPM Test <br /> ❑Collection Station ElAgriculture Source A&S Environmental Services as the transporter of vour TOTAL <br /> Government Source ❑Industrial Source Hazardous waste may use another licensed transporter to CHARGES <br /> 0 Marine Source haul your waste to a designated facility. <br /> DESIGNATED TSDF: ❑EVERGREEN ENVIRONMENTAL• 80 Smith Avenue•Newmark.CA•CAD982413262•(800)972-5284 <br /> D RAMOS ENVIRONMENTAL• 151S.River Road-W.Sacramento.CA 95691•CAD044003556•(916)371-i747 <br /> ❑RIVERBANK OILTRANSFER• 5300 Claus Road-Riverbank.CA 95367•CALOOOIQ081 G•(209)863-8181 <br /> 0 ALTERNATE FACILITY <br /> O 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 1:21,,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 1 HEREBIdCERTIFIing eTHAT I HAVE NOT A•1[ED THIS WASTE WITH ANYy's fees.will be added to past due accounts placed for eOTHER <br /> the applicable regulations of the Department of Transportation. WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1Ul)tl P.P.M.:AND THAT <br /> THE WASTE DOES NOT CONTAIN ANY PCB'S. <br /> DRIVER SIGNATURE <br /> GENERATOR'S SIGNATURE AMOUNT DUE IN 30 DAYS <br />