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Samos Environmental - <br /> Serv� Ces - <br /> 1515 South River Rd, <br /> West Sacramento, C <br /> (918) 371 -5747 6569? R <br /> N CAD044003556 <br /> \ 4 9 rt <br /> C4 FNV'RONMEIV <br /> SERV' CE, ORDER SER g 7-/SERWCE8 <br /> BILL OF LAD ORDER NO. <br /> DATE � � � 172444 <br /> GENE <br /> BATOR S I <br /> BILLING ADDRESS —_ l c � JOB NUMBER <br /> GENERATORi ------ <br /> EPA # <br /> GENERATOR CONTACT b <br /> _ PHONE AMOUNT <br /> OF AN i. <br /> S Y 7 <br /> JOB SITE ADDRESS 3`— CHECK NUMBER % �; <br /> PooNUMBEjj <br /> � L � i - . : Li r✓ Iva ( , <br /> JOB DESCRIPTION CASH RECEIVED �— <br /> � ' /•' / , .- % + HALIDES (amt.) <br /> P. P.M. <br /> MATER,ALS. <br /> NON RCRA HAZARDOUS <br /> WASTE �r <br /> Lf QUID, (USED pI� <br /> NON RCRA HCODE . . .HAZARDOUS WASTE, <br /> WASTE. �r <br /> SOLID _ <br /> START 71ME _� <br /> U.S. t)aT DESCRIPTION: LIQUID CODE p --. <br /> (� ON: - -- ----_ _ _ ARRIVE TIME <br /> u (USED �� • % 7 <br /> ANTI-FREEZE) ON LEAVE JOB <br /> MANIFEST N0. r, RCRq HAZARQOUS WAS7E LIQUID STOP TIME <br /> ,� . oe <br /> CODE - <br /> DRIVER'S SIGNATURE � .. - l <br /> _ USED OIL FILTERS <br /> DESIGNATED TSDF: NO. OF tom'- Driums o <br /> RAMOS ENVIRON GALLONS <br /> MENTAL SERVICES. TRUCK # _ <br /> HEREBY C 1515 SOUTH RIVER RD. WEST <br /> Q <br /> CERTIFY THAT t NAVE SACRAMENT0 '5691 <br /> Lo This is to NOT MIXED THIS 0 95691 CAO 044003556 V <br /> certify that the above WASTE WITH ANY OTHERa <br /> transportation according to names articles WASTE <br /> Generators g the applicable are Properly classified AND THE TOTAL HALIDES ARE <br /> C�tifrcation: l certify that t h regulations of the De described, paces LESS THAN 1000 PPM <br /> `� to be economicalry Pfacticabfe have a os program in partment of Transportation. Sed, marked and are i ~ <br /> oAll Ramas' slandardRed- permit[ fora green tivith gen�eratoroou� the volu n proper condition for <br /> the me and toxic <br /> I ge facility, end alt their hazy (h' of waste genuted to the degree <br /> `y �O� vraste to an authorizer) hazardous t have det <br /> from generator fists ermine <br /> waste treatment facility <br /> Terms _ net d above wil! be imported only <br /> After dye d Y to a facility permitted b <br /> costs a atr�Ys- Y the State of C us <br /> and att a afifornla to accapt � <br /> ' nC charge or 1 .50 °Yn er oil. <br /> declare under I S rncu?ed in tha collection <br /> g� oftthis o18, 00 to�nuaf rate, w71 be <br /> • Venue for wed °n the unpaid balance, <br /> of perjury that the for purposes of <br /> eOn them The customer a <br /> �0rn9 rs true and correct ent of ibis obligation shall be Yofo es to Pay reasonabfe <br /> County. <br /> 241 � <br /> X <br />