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A&S Environmental Servic s Bill of Lading/Invoice <br /> P.O. Box 186 <br /> LaGrange, CA 95329 For Service <br /> (209) 538-0886 / Fax (209 538-2498 800-760-0019 <br /> EPA# CAR000176537 <br /> Date <br /> JOB LOCATION BILLING INFORMATION <br /> NAME NAME CASH❑ CHECK❑ <br /> ADDRESS V� ADDRESS CONTACT NAME <br /> CITY STATE ZIP CO CITY STATE ZIP CO POS$ <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 Only) <br /> Used oil,Non-RCRA Hazardous Waste,Liq id CA 221 !f, Gal <br /> Used Automotive Antifreeze,Nott-RCRA H 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 dip Each <br /> Waste Flammable Liquid Paint CA 331 Gal <br /> Other: OCT <br /> r <br /> 2017 <br /> Other: <br /> Other: ENVIRON107,77= <br /> Other: - <br /> Other: <br /> Tax <br /> TEST ASS'Q FAIL❑ PPM Test <br /> ❑Collection Station ❑Agriculture Sour(e A&S Environmental Services as the transporter of your TOTAL <br /> ❑Government Source ❑Industrial Source Hazardous waste may use another licensed transporter to CHARGES <br /> ❑Marine Source haul your waste to a designated facility. <br /> DESIGNATED TSDF: ❑EVERGREEN E IRONMENTAL- 80 Smith Avenue•Newmark,CA-CAD982413262•(800)972-5284 <br /> LI RAMOS ENVIR NMENTAL- 151S.River Road•W.Sacramento,CA 95691•CAD044003556-(916)371-5747 <br /> ❑RIVERBANK O L TRANSFER- 5300 Claus Road-Riverbank,CA 95367-CAL000190816-(209)863-8181 <br /> ❑BEST ENVIRO MENTAL- 2430 Almond Drive-Silver Springs,NV 89429•NVD982358483•(775)577-9001 <br /> ❑ALTERNATE F ILITY <br /> ❑ALTERNATE F ILITY <br /> This is to certify that the above named articles 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 con ition 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 T nsportation. 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 />