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nvi ronmental Services Bill of Lading/Invoice <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 Date <br /> iF <br /> JOB LOCATION BILLING INFORMATION <br /> N . NAME CASH 0 CHECK 0 <br /> ADDRESS ADDRESS CONTACT NAME <br /> P;:;�,/5 A/A U tZ i) w'i <br /> CITY ' SyT�1E ZIP - CO CITY STATE ZIP CO PO# <br /> PHONE NO. PHONE NO. PROFILE NO. = �TOjwIER EPA ID q <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER (For Time Of Service Only) <br /> Used oil,Non-RCRA_Hazardous Waste,Liquid CA 22] A^ � Gal xM� f <br /> Used Automotive Antifreeze,Non-RCRA Hazardous CA 134 I`v 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 -' e <br /> Labor Hours <br /> Waste Flammable Liquid Gas CA 133 Gal <br /> Non-RCRA Hnardous Waste Solid ✓ CA 352 (F.lir 71{ f ''1 I•� ! c'(� i"� <br /> Waste Tires Each <br /> Waste Flammable Liquid Paint CA 331 Gel. <br /> .Other: <br /> Other: <br /> Other: <br /> Other: <br /> other: <br /> -Tax- <br /> TEST <br /> Tax TEST PASS C3FAIL 0 PPM Test <br /> O Collection Station 0 Agriculture Source A&S Environmental Services as the transporter of your TOTAL <br /> O Government Source 0 Industrial Source Hazardous waste may use another licensed transporter to CHARGES �3 I <br /> 0 Marine Source bawl your waste to a designated facility. <br /> DESIGNATED TSDF: 0 EVERGREEN ENVIRONMENTAI,• 80 Smith Avenue-Newmark,CA•CAD982413262•(800)972-5284 <br /> 0 RAMOS ENVIRONMENTAL.+ 151S.River Road-W.Sacramento,CA 95691-CAD044003556-(916)371-5747 <br /> 0 RIVERBANK OIL TRANSF'kR• 5300 Claus Road•Riverbank,CA 95367-CAL000190816•(209)863-8181 <br /> .t. <br /> 0 BEST ENVIRONMENTAL•"2430 Almond Drive-Silver Springs,NV 89429-NVD982359493•(775)577-9001 <br /> 0 ALTERNATE FACILITY <br /> 0 ALTERNATE FACILITY <br /> This is to certify that the above named articles are properly classified,described,pack- A service charge of 11/2%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 regul�tions of the Department of Transportation. I HEREBY CERTIFY THAT I HANE NOT MIXED THIS WASTE WITH ANY OTHER <br /> WASTE,THAT THE TOTAL HALIDES ARE LESS THAN 1000 EEM.;AND THAT THE <br /> -- —^.y ---- WASTE DOES NOTCONTAINANYPCB'S. <br /> DRIVEk SIGNATURE GENERATOR'S SIGNATURE AMOUNT DUE IN 30 DAYS <br />