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A&S Environmental Services Bill of Lading/Invoice <br /> P.O. Box 186 For Service 21*J`l <br /> LaGrange, CA 95329 <br /> (209) 538-0886/ Fax (209) 538-2498 800-760-0019 <br /> EPA# CAR000176537 Date <br /> JOB LOCATION BILLING INFORMATION <br /> NAME r ,1 r //) NAME CASH O CHECK❑ <br /> / <br /> ADDRES-^ ADDRESS CONTACT NAME <br /> CIT)�—'¢f i t <br /> STATE ZIP CO CITY STATE ZIP CO PO# <br /> k- <br /> E•II�Q N(.•�. PHONE NO. PROFILE NO. ;�t7 TOMER Ep- in,,, <br /> - - - - - :U f <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER (For Time Of Service Only) <br /> r- <br /> Used oil,Non-RCRA Hazardous Waste,Liquid CA 221 Gal ti •�1 i <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 /> 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 Gal <br /> Other: <br /> Other: <br /> Other: <br /> Other: <br /> Other: <br /> Tax.. <br /> TEST PASSA, FAIL❑ PPM Test <br /> -]-Collection Station ❑Agriculture Source A&S Environmental Services as the transporter of your TOTAL <br /> Q Government Source ❑Industrial Source Hazardous waste may use another licensed transporter to �11` !ir <br /> ❑Marine Source haul your waste to a designated facility. CHARGES <br /> ru•i <br /> DESIGNATED TSDF: ❑EVERGREEN ENVIRONMENTAL• 80 Smith Avenue•Newmark,CA•CAD982413262-(800)972-5284 r <br /> ❑RAM OS ENVIRONMENTAL• 151 S.River Road•W.Sacramento,CA 95691 •CAD 044003556• 916 3 71-5 74 7 ! <br /> ❑RIVERBANK OIL TRANSFER• 5300 Claus Road•Riverbank,CA'95367•CAL000190816•(209)863-8181 <br /> 1 1-BEST ENVIRONMENTAL• 2430 Almond Drive•Silver Springs,NV 89429•NVD982358483•(775)577-9001 <br /> ❑ALTERNATE FACILITY <br /> ❑ALTERNATE FACILITY <br /> This is to certify thatbe above named articles are properly classified,described,pack- A service charge of 1 1/2a/per month shall be charged on all past due accounts.Collections <br /> aged,marked andlIlab l4 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 refit i ft of the Department ofTransport ,V"7 I HEREBYI CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY OTHER <br /> 77 ` WASTE,THAT:F1TOTAL HALIDES ARE LESS THAN 1000P.P.M.;ANDTHATTHE <br /> fir• ATE DOES N07tiCONTAIN ANY PCH'S. <br /> DRIVER Slr NATURE GENERIATOR S SIGAATURE ! AMOUNT DUE IN 30 DAYS <br />