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-A&SJ Environmental Services Bill of Lading/invoice <br /> P.O. Box 186 ��7�4 <br /> LaGrange, CA 95329 For Service ti° <br /> (209) 538-0886/ Fax (209) 538-2498 800-760-0019 <br /> EPA# CAR000176537 Date <br /> JOB LOCATION BILLTNG INFORMATION <br /> NAME a NAME: CASH L3 CHECK Ll# <br /> ADD ADDRESS CONTACT NAME <br /> Cp. 'LIP CO CITY STATE ZIP CO PO# <br /> P U ` PHONE NO. PRCFIL.NO. F.R <br /> /� <br /> PRODUCT WASTE MA14IFF.ST QUANTITY UNIT'S PRICK AMOUNT <br /> CODE NUMBER (ForT'ime Of Service Only) <br /> Used oil,Non-AURA Hazardous Waste,Liquid CA 221 /� Gal <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 Drttrt . <br /> Empty Drt:m Pick Up Drum <br /> Drained Used Oil'ilten; Drum <br /> Labor Hours <br /> Waste Flammable Liquid Gas CA 133 Gal <br /> Non-RCRA Hazardoas Waste Solid CA 352 <br /> Waste Tires Each <br /> Waste Flaruaable Liquid Paint CA 331 Gal <br /> Other. <br /> Other: <br /> Other. <br /> Otho: _ <br /> Other: <br /> TEST PA FAIL❑ PPM Test <br /> Rection Station ❑Agricuhuro Se A&S Environmental Services as the transporter ofyour TOTAL, <br /> ❑Government Source ❑Industrial Sgt(r. Hazardous waste may use another licensed tTanaporter to <br /> C1!uterine Source haul your waste to a designated facility. CHARGES <br /> rBS <br /> DESIGNATED T'SDF: ❑EVERGREEN FNVIRONMENTAL• 80 Smith Averse-Newmark,CA•CAD982413262•(800)972-5284 <br /> ❑RAMOS ENVIRONMENTAL• ISIS.Rivet Road•W Sacramento,CA 95691•CAD044003556•(916)371-5747 <br /> ❑ OILTRANSFER• 5300 Claus Road-Riverbank,CA 95367•CAL000190816-(209)863-8181 <br /> F ENVIRONMENTAL• 2430 Almond]hive•Silver Springs,NV 89429•NVD982358483•(775)577-9001 <br /> ALTERNATE FACILITY <br /> ❑ALTERNATE FACIGITY i <br /> Ms is to certify the above named articl=are properly classified,described,pac - Aservice charge of I Ir2%per mootb shall be ehmged on all past due accounts.Collections <br /> aged,marked and labeled,and are in proper condition for transportation,sccord' to coats,including anorneO fees,will be added to peat duo accounts placed for collections. <br /> the applicab.'e regulations othheD partme ✓af TYansportatiop,�' LATHATTIIETOTAL <br /> C IFY THAT I HAVE NOT bII?®THIS WASTE wn-H ANY OTHER <br /> IIAI-IDFSAREI.ESSTHAN.'000 Y.P.M;ANDTHATTHE <br /> ES OT CONTAIN ANY PCB's. <br /> DRIVER SIGNATURE TO 'S SIGMA E AMOUNT.DUE IN 30 DAYS <br />