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&environmental Services Bill of Lading/Invoice <br /> P.O. Box 186 , q — p <br /> LaGrange, CA 95329 For Service r . .a3 <br /> (209) 538-0886/Fax (209) 538-2498 800-760-0019 rr <br /> EPA# CAR000176537 Date <br /> JOB LOCATION BILLING INFORMATION <br /> NAME <br /> CASH U CHECK D <br /> ADDRESS ADDRESS CONTACT NAME <br /> CI r S7 ZIP ZIP CO CITY STATE "LIP CO P0# <br /> PHONh NO. PHONE NO. PROFILE NO. I1^S;OMF3 EPA i tl <br /> PRODUCT WASTE MANIFEST QUANTITY UNITS PRICE A1tOUNT <br /> CODE NUMBER (Far Time Of Service Only) <br /> Used oil,Non-RCRA Hazardous Waste,Liquid CA 22] L4� Ga: <br /> Used Automotive An freeze,Non-RCRA Hazardous CA 134 Ga: <br /> Waste,Licuid <br /> Non-RCRA Hazardous Waste Liquid CA 221 Ga. <br /> Jsed Oil&Water <br /> Oil&Water,Non-RCRA Hazardous Waste Liquid CA 223 Ga. <br /> Empty Drum Delivery Din <br /> Empty Drum Pict Up Drum <br /> Draked Used Oi:Filters Drum <br /> Lebo: Hours <br /> Waste FL=unable Liquid Gas CA 133 Ga• <br /> 1 .y <br /> Nor-RCRA Hazardous Waste Sohd V CA 352 <br /> Waste Ties Each <br /> Waste Flammable Liquid Paint CA 33: Gal <br /> Other: <br /> Other: <br /> Other: <br /> Other: <br /> Otho: <br /> Tax <br /> TEST PASS U FAIL U PPM, lest <br /> D Collection Station D Agriculture Source A&S Environmental Services as the transporter of your TOTAL -.— <br /> ❑Government Source U Indusnal Source Hazardous waste may use another licensed transporter to CHARGES / <br /> D Manne Source haul your waste to a desigrated facility. <br /> DESIGNATED TSDF: U EVERGREEN ENVIRONMENTAL.- 80 Smith Avenue-Newmark,CA-CAD982413262 (800)972-5284 <br /> U RAMOS ENVIRONMENTAL- i 51 S.River Road-W.Sacramento,CA 95691-CAD(A4003556-(916)371-57 47 <br /> U RI VERRANK OIL TRANSg7 - 5300 Claus Road-Rive-bank,CA 95367-CAL000190816-(209)863-8181 <br /> U BEST ENVIRONMENTAL.- 2430 Almond Drive-Silver Springs,NV 69429-NVD982358483-(775)577-9001 <br /> U ALTERNATE FACILITY <br /> D ALTERNATE FACILITY --- <br /> This is to certify that the above named articles are properly classified,described,pack. A service charge of 1 1/274 per month shall be cnarged on all past out accounts.Collections <br /> aged,marked and labeled,and are in proper condition for transportation,according to costs,including atiomey's fees,will be added to past due accounts placed for ccilections. <br /> the applicable regulations of the Department of Transportation. 1 Y.ERL-BY CERTIFY THAT I HAVE NOT MIXED THIS WASTE WITH ANY OTHER <br /> f WASTE,THAT TE E TQTAL HALIDES ARE LESS THAN 1000 P.P.M.;AND THAT THE <br /> WASTE DOES NOT CONTAIN ANY PCR'S. <br /> DRIVER SIGNATURE GENERATOR'S SIGNATURE AMOUNT DUE IN 30 DAYS <br />