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A&S Environmental Services Bill of Lading/Invoice <br /> P.O. Box 186 r <br /> LaGrange, CA 95329 For Service <br /> (209) 538-0886 / Fax (209) 538-2498 800-760-0019 <br /> EPA# CAR000176537 Date <br /> JOB LOCATION BILLING INFORMATION <br /> NAME,_a NAME CASH❑ CHECK ❑ <br /> # <br /> ADDRESSI ADDRESS CONTACT NAME <br /> ,iy- I�'^S k u�•' <br /> CITY __1_ 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 Of Service On]NI) <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 <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 I Hours <br /> Waste Flammable Liquid Gas CA 133 Gal <br /> Non-RCRA Hazardous Waste Solid CA 352 Gal <br /> Waste Tires <br /> Waste Flammable Liquid Paint CA 331 Gal <br /> Other: <br /> Other: <br /> Other: <br /> Other: <br /> Other: <br /> Tax <br /> TEST j FAIL❑ PPM Test <br /> Collection Station ❑Agriculture Source A&S Environmental Services as the transporter of your TOTAL <br /> s ❑Govemment Source ❑Industrial Source Hazardous waste may use another licensed transporter to CHARGES H <br /> 13 Marine Source haul your waste to a designated facility. <br /> DESIGNATED TSDF: ❑EVERGREEN ENVIRONMENTAL- 80 Smith Avenue-Newmark,CA-CAD982413262•(800)972-5284 <br /> _,'RAMOS ENVIRONMENTAL• 151S.River Road-W.Sacramento,CA 95691-CAD044003556•(916)371-5747 <br /> ❑RIVERBANK OIL TRANSFER• 5300 Claus Road•Riverbank,CA 95367•CAL000190816•(209)863-8181 <br /> ❑ALTERNATE FACILITY <br /> ❑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 W%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,including attorney's fees,will be added to past due accounts placed for collections. <br /> the applicable regulations of the Department of Transportation. I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY OTHER <br /> V = WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.;AND THAT <br /> THE WASTE DOES NOT CONTAIN ANY PCB'S. <br /> DRIVER SIGNATURE _ GENERATOR'S SIGNATURE AMOUNT DUE IN 30 DAYS <br />