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A&S Environmental Services Bill of Lading/Invoice <br /> P.O. Box 186 'T <br /> 14 <br /> LaGrange, CA 95329 For Service �a <br /> (209) 538-0886/ Fax (209) 538-2498 800-760-0019 <br /> EPA# CAR000176537 Date <br /> JOB LOCATION BILLING INFORIMATION <br /> NAME /I / f NAME CASH❑ CHECK❑ <br /> ADDRES& `l L t ADDRESS CONTACT NAME <br /> 6 <br /> /4.1 . <br /> e <br /> CIT1r STATE ZIP CO CITY STATE. ZIP CO PD#f <br /> EFjQKE 'S J _�JU PHONE NO. PROFILE NO. A 1C OMER EPS o ) <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE AMOUNT <br /> CODE NUMBER (For Time O`Servi=Only) <br /> Used oil,Non-RCRA Hazardous Waste,(:.quid CA 221 Gal C; /�✓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 E{azardous Waste Liquid CA 223 Gel <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 Gel <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 PASSAL FAIL❑ PPM 'Fest <br /> &Collection Station ❑Agriculture Source A&S Environmental Services as the transporter of you- TOTAL � /I <br /> ❑Government Source ❑Industrial Source Hazardous waste may use another licensed transporter to CHARGES J ' <br /> El Marine Source haul your waste to a designated facility. <br /> I t <br /> i <br /> DESIGNATED TSDF: ❑EVERGREEN ENVIRONMENTAL• 80 Smith Avenue-Newmark,CA-CAD982413262•(800)972-5284 c ' 40 .1 <br /> ❑RAMOS ENVIRONMENTAL• ISIS.River Road-W.Sacramento,CA 95691•CAD044G0355(,-(916)37i.5741 1 �� <br /> ❑RIVERBANK OILTRANSFER- 5300 Claus Road•Rive-wank,CA 95367•CAL000!90816-(209)863-8181 <br /> O-BEST ENVIRONMENTAL• 2430 Almond Drive-Silver Springs,NV 89429-NVD98235w-,•(775)577-9001 <br /> ❑ALTERNATE FACILITY <br /> ❑ALTERNATE FACILITY <br /> Trus is to certify that the above named articles air properly classified described pack- A smite charge of 1 112%per month shall be charged on all past due accounts. Collections <br /> aged marked and la f i and are in,proper condition for transportation,according to costs,inclu mg evorney's fees,wil.be added to pas:due accounts placed for collections <br /> the applicable rett11 do of the Department ofTrnrspor.. tic .'7 I IIE•REBY�CL'RTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY OTHER <br /> 7 WASTE,THAT TCTALHALIDFSARELESS TEIAN IOOOP.P.M.;ANDTHAT TFIE <br /> / ATF.DUBS N11 CONTAIN ANY PCB'S. <br /> ' � a <br /> DRIVER S�(F,N,-;TUBEGEN''_R'hTOR'S SIONATURE AMOUNT DUE 1N 30 DAYS <br /> J - <br />