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A&S'Environmental Services Bill of Lading/Invoice <br /> P.O. Box 186 <br /> LaGrange, CA 95329 For Service <br /> 800-760-0019 <br /> (209) 538c--08861 Fax (209) 538-2498 ; + <br /> EPA# CAR000176537 Date <br /> JOB LOCATION BILLING INFORMATION <br /> r / . NAME CASH❑ CHECK ElNAME # <br /> ADDRES i ADDRESS CONTACT NAME <br /> C7. STATE ZIP CO CITY STATE ZIP CO POi <br /> PITON�NO.f.�-^� _ J PHONEY NO, PROFILE NO. CIiItSTO R EPJD NO. <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 221' -Gal <br /> r <br /> // <br /> Used Automotive Antifreeze,Non-RCrtA 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 Hazaidous Waste Liquid CA 223 Gal <br /> Empty Drum Delivery Drum <br /> Empty Drum Pick Up Drum - <br /> Drained Used Oil Filters Drum <br /> Hours <br /> Labor <br /> Waste Flammable Liquid Gas CA 133. Gal <br /> Non-RCRA'Hazardous Waste Solid CA 352 <br /> Each <br /> Waste Tires <br /> Waste Flammable Liquid Paint CA 331 Gal <br /> Other: <br /> Other: <br /> Other <br /> Other. <br /> Other: <br /> Tax j <br /> TEST 4 PSS FAIL❑. PPM Test <br /> Collection Siatlon ❑Agriculture Sou,e A&S Environmental.Services as the transporter of your T(? <br /> �y <br /> ❑Government Source Cl Industria Sol Hatardous'waste may use another licensed transporter to. CHARGES ✓2 ' <br /> ❑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• 1518.RivcrRoad i W.Sacramento;CA 95691•CAD044003556•(916)371-5747 ' <br /> ❑RIVERBANK OIL TRANSFER• 5300 Claus Road•Riverbank,CA 95367•CAL000190816•(209)863-8181 <br /> 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-that-lhe-above•named articles are-proporly classified,-dosrnbed,-packL A.acr r=hnrge of 1 1/2%pm=.d s all be charged on all pest due accounts,Collections <br /> aged,marked And labeled,and are.m proper con lion for transportation,accortling to cupMludi.,Sattomey%-fees;H l-beadded-t past-due-neeounts-pleoed-for collections--- <br /> the applicable regulations the.Department ofT apsportation I HEREBY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY OTHER <br /> �/ <br /> WASTE,THATTHETOTALHALIDES ARE LESS THAN 1000ERM.;AND'fHATTHE <br /> f !•�j <br /> jWASTE DOES NOTZANY*I'CB,DRIVER SIGNATURE GEEO .SIRE AMOUNT DUE IN 30 DAYS <br />