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A&S Environmental Servic s Bill of LadinWInvoice <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 <br /> Date H <br /> JOB LOCATION BILLING INFORMATION <br /> NAME NAME CASH❑ CHECK❑ <br /> A # <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 /> ,++s•ti ter. �`'r _ <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER (For Time Of Service Only) <br /> Used oil,Non-RCRA Hazardous Waste,Lic uid CA 221 `iJ/ t Gal <br /> Used Automotive Antifreeze,Non-RCRA ardous 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 /> Waste Tires Each <br /> Waste Flammable Liquid Paint CA 331 C,• <br /> Other: u <br /> Other: <br /> Other: <br /> Other: IENVI RONMEWAL EALTH <br /> Other: 5 RV! ES <br /> Tax <br /> TEST PASS❑ FAIL❑ PPM Test <br /> ❑Collection Station ❑Agriculture Soce A&S Environmental Services as the transporter of your TOTAL <br /> Ll Government Source ❑Industrial Sour a Hazardous waste may use another licensed transporter to CHARGES <br /> ❑Marine Source haul your waste to a designated facility. <br /> DESIGNATED TSDF: 0 EVERGREEN ENVIRONMENTAL• 80 Smith Avenue•Newmark,CA•CAD982413262•(800)972-5284 <br /> ❑RAMOSE RONMENTAL• 151S.River Road•W.Sacramento,CA 95691 •CAD044003556•(916)371-5747 <br /> ❑RIVERBANK DIL TRANSFER• 5300 Claus Road•Riverbank,CA 95367•CAL000190816•(209)863-8181 <br /> ❑BEST ENVIR NMENTAL• 2430 Almond Drive•Silver Springs,NV 89429•NVD982358483•(775)577-9001 <br /> ❑ALTERNATE ACILITY <br /> ❑ALTERNATE ACILITY <br /> This is to certify that the above named articles are properly classified described,pack- A service charge of 1 1/2%per month shall be charged on all past due accounts. Collections <br /> aged marked and labeled,and are in proper c4 indition 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 o_ Transportation. I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY OTHER <br /> WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 P.P.M.;AND THAT THE <br /> WASTE DOES NOT CONTAIN ANY PCB's. <br /> DRIVER SIGNATURE GENERATOR'S SIGNATURE AMOUNT DUE IN 30 DAYS <br />