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Oct 01 09 05: 17p Jeff Kindorf 2098207818 p. 2 <br /> �...r,..: ''$ a "f^` f�•' Bili of Lading/Invoice <br /> A&S Environmental Services <br /> P.O. Box - �t< ..•'�5��'. <br /> 186 w>. <br /> For.Service <br /> LaGrange, CA 95329 800-760-0019. <br /> (209) 538-0886/ Fax .(209)538-2-498 <br /> EPA# CAR000176537 Date <br /> JOB LOCATION BILLING INFORMATION <br /> CASH 0 CHECK 0 <br /> NAM NAME <br /> ` r, C <br /> ADDRES. <br /> ' r ADDRESS. . CONTACT NAME <br /> :CITY' STATE ZIP CO CITY STATE. ZIP CO PO r <br /> sr <br /> ;: TOMER EPA ID NO <br /> PROFILE VO_ <br /> •PH NE7 O,^. -. PHONE NO. <br /> • nth,.. -���-.-- � _ <br /> PRODUCT.- — --..,— WASTE —� MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER (For.Time Of Service Only) <br /> Used oil,.Non-RCRA Hazardous R'aste,Liquid. CA 221 Gal <br /> Gal <br /> Used Automotive Antifreeze,Non-RCRA Hazardous CA 134 __............_.. ._:... <br /> Waste.'L•ignid <br /> Won-RCRA Hazarddus.Waste Liquid <br /> C:4 221 Gal . <br /> Used Oil&Water. <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA 223 Gal <br /> Drum. 1. �.e+ <br /> Empty Drum.Delivery <br /> Drum <br /> Empty Drum Pick Up <br /> .. � Drum ' 4./ <br /> Drained Gsed Oil.Filters . <br /> Hours <br /> Labor <br /> CA 1333 3 Gal ! ` <br /> Waste Flammable Liquid Gas 3 <br /> fists} ,. +t <br /> -Non-RCRtY HCA 352 GaL <br /> azardous Waste Solid <br /> Wasiis Tires <br /> Waste Flammable Liquid Paint CA 331 Gal , <br /> . Ottier:' 7r C'sD,�'~ .?�.. ,r7 �..),.��� •-'w - <br /> Other: <br /> Other: <br /> Other: <br /> Other: <br /> .Tax. <br /> TEST PASS O FML i3 PPM Test <br /> ELO)MEnine <br /> ection Station 0 Agriculture Source A&S Environmental Services as the transporter of your TOTAL <br /> ernment Source 0 Industrial Source Hazardous waste may use another licensed transporter to CHARGES <br /> Source haul your waste toad esignated facility. <br /> DESIGNATED TSDF: p EVERGREEN ENVIRONMENTAL• 80 Smith Avenue•Newmark,CA•CAD982413262•(800)972-5284 <br /> ❑FLkMOS ENVIRONMENTAL• 151 S.River Road•W.Sacramento,CA 95691•CAD044003556-(916)371-5747 <br /> Z)RIVERBANK OIL TRANSFER• 5300 Claus Road•Riverbank,CA 95367•CAL000190816•(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 property classified,described,pack- A service charge of 1 1l2%per month shall be charged on all past due accounts. Collections. <br /> aced marked and litbeJed.and are in proper condition for transportution,according to 'costs,including.agorney's fees,will be added to past due accounts placed for collections. <br /> the applicable and <br /> 1 tions of the Department o clition for tran,._, I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY OTHER <br /> .1 r WASTE THATTHE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.;AND THAT <br /> WASTE DOES NOT CONTAIN ANY PCB'S. <br /> DRIVER SIGNATURE GENERAT'OR'S SIGNATURE A1v10UNT DUE LV 30 DAYS <br />