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<br /> NON-RCFA- AZAI [?O 1NAST , 1-IyQUI (USED OiL/MIXED OILS) NQ PL iCARDS REQIJIR D* STATEN%— 221
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<br /> DESIGNATED TSDF: ' r , tlowum -4, 49 fit $414 4kd 04 99 U940
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<br /> This is to certify, that the waste described above is properly classified; described, packaged, marketl and labeled; and is in proper condition for transportation, according to applicable State
<br /> and 'federat regulations. By signing below I also hereby certify that AI
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<br /> mixed an of the waste ileacribed above with, any otharfiazardoua waete,,the.iotat halide confent isl�$Sithin 1 ,OOp, ppm, and waste does not contain anyPCs. r have in
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<br /> complied-with the requirements of the appllcable California usednil management reguletiensto determine this is true: l agree to accept the additional charges for`tha dispos`al'of this wa§'fe' !
<br /> If the information 1 have provided about this waste is incorrect
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<br /> A 41#2 i have not mixed any of the waste described above with an'y*other hazardous wrl An astes the total halide contenfiCIA s CR ATER<thari 1;000 spin; Arid the waste floes not`contairi any PCBs. "s
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<br /> have provided propaydocnmentation,to Asbury Environmental Services to rebutthe presumption that this waste was mixed with other hazardous waste, l agree to accept the additional charges i
<br /> for the,disposal`of this waste If the information lihave provided about this waste is Incorrect
<br /> N3j This waste Ia from a tank which collects waste o0 from household "do•it•yourself'. (w) and/or conditionally exempt small quantity generator (CESQG) sources. To the bast of my
<br /> knowledge, the only waste oil contained in my 1)IY/ CESQG collection tankas Soley from DIY and/or GES4G sources: t have not mixed this waste oil with any bther hazardous waste or
<br /> waste ,oti from 'other, sources: l agree to accept the additional charges for disposal of thla waste`if the information I have provided ab
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<br /> waste is incorrect ; ;
<br /> (All generators/customers MUST readthe following -text and check the associated box.)
<br /> C <,) if l am a large quantity generator, t certify that i have a program in place to reduce the volume ,and toxicity of waste generated to the degree i have determined to be economically `
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<br /> actias Is and, that i have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threaflto human life and ;,)
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<br /> e environrnent Or, If t am a smelt quantity generator, i have made a good faith effort to minimus my waste generation and select the bAA
<br /> est este management method that is available
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<br /> nCus ome Signature - - ~Date P`ADriver'St�nature ' Date '
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