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<br /> STATE CODE 221
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<br /> 1 A iAZAF2Dt)(1S<WASi E; 1:IGlU�D (ETHYLENE GLYIS
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<br /> i # SA RECA 'KYGLINQ . �3E90 iNestern"Avenue, Uriiorr City; GSA 84 87 " 1 =5-SID 4 a % IS877-9277 " ' `
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<br /> DRUMS PNs �' EMPTY AS�QRUMS FACILITY. , = BSC t41 A
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<br /> t , ; =i l x ft ; > r t }GENERATOR WASTE CERTIFICATION � ' "a ' r : z ,
<br /> PLEASE{ CHECK=THEw 'APPROPRIATE = BOX ' = > ; x � � % SAN, .i
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<br /> This is to certify, that the waste described above Is properly cfassified, describeds pacCt
<br /> IfA . kaged, marked and labeled, and Is in proper condition for transportation, according to applicable Staf v
<br /> and federal regulations. By signing below 1 also here4y certify that: � �TV
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<br /> r (Waste#pit generator/cstomr N1UST _ ck 4NE ofthe follouyinig thrtYejaxes) _ $
<br /> 1 -110 #1 )'a have not mixed anys'of the waste described above with any other hazardous waste,~the total halidIII e content Is.LESS than 1 ,900 'ppm, and the waste floes not contain any}PCOs I have
<br /> compiled with the requirements.of the applicable California used oil management regulation 's to Bete[mine this is true. I agree to accept the additional charges forthadisposallof tf�is Waste
<br /> If the Information I have provided about this waste Is incorrect
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<br /> I] .#2 I have not mixed any of the waste described above w)tNanytBther#iaz5rdous,waste, the total) halide content-is t3R�ATER tha`ri x,000 ppm;"and the"
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<br /> 13 %#2) 1 not`contain any pCes.' t
<br /> have provided proper documentation }o Asbury fnvlronmentai Services to rebut the presumption that this waste was mixed with other hazardous waste, i agree to accept the additional charges
<br /> = tor` the disposal of this waste if the Information t have provided about this waste is incorrect`
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<br /> I #3)This waste is from a tank which collects waste oil from household "do-it-yourselr' (DIY) and/or conditionally exempt small quantity generator (CESQG) sources. To the best of my ;
<br /> knowledge, the only waste oil contained in my DIY/ CESQG collection tank is solay.from DIY and/or CESQG sources. l have not mixed this waste oil with any other he waste or
<br /> waste oil from other sources. ) agree to accept the additional charges for disposal of this% waste if tha information 1 have provided about this waste is incorrect
<br /> (AlhgeneraEorsjAt I custorriers MUST read the following text and check the associated box.)
<br /> #4} H 1 am a large quantity generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to ba economically
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<br /> zcticable and that I have selected the practicable method of treatment%, storage,"ordisposai currently available to me which mini %mizes the present and future threat human life and
<br /> ' 'the epvironment; Or, It Lama small quantity generator, i have made a good felth;effort to minimliamy,waste generation and select the beat waste management fpathod tt�at is available
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