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<br /> COSTO x PU CHASE 013D R# i 0l7� E,,,#` {,J Tt�UCK�}�� r#CONIA�T NAMEi��„ �f�?�D)=R T!o`R�N��Y _spy.:x HPaLID
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<br /> D TE REQI�IRED DATE ENTERED NEXT SERVICE PATE" CUSTOMF,.R EPA# MANIFEST# �
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<br /> PART QTY U►+�ITPy�ItE QDA
<br /> TPI� -` TOTAL.
<br /> 3r<;rl mi " Irl _#Wk M, i3 `v 3s r.aifrf?°_1 "3f91,. •` :' i is •Jff4 i €je,.. .:J
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<br /> NOt =RC R ODS Y17ASTE;UQUID'(ETHYLENE GLYCOL SOLUTIONS)* O PLACARDS REQUIRED" STATE 0p
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<br /> ALTERNATTSbF ii ear x
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<br /> X51 RE`GYCG{{IiSG 20 5 EI 15' Sri ee Los Angelesr GA 9001 ( M 645 358
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<br /> ` D(� i*71+.}.Rx t FACX1TY - xa a t.` era* 3,="-t `3_#.�i w x,�ks',:3r r't I« �£�E•�.t!
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<br /> 3CaENER�iTO'RWAS'TE"CER7IF CATION: t r, t• t,
<br /> t RLEAS°EYC #E K -I*-,kPPROPRIATE?903 q` e35Y' ''
<br /> This Is-to card fy that thevta"ata described above Is property clas"aided,described;packaged;marked and libel ed:ani!isin:properdbrilitlort for transportation,according to applicable State
<br /> and federal regulatio s By slyni p below i al o hereb certify that' " ,
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<br /> . j.r #ix 7 ��3 il, r,: `silo 06 c5'€} �'. ,` � ''S f f t r
<br /> �' - e wast'iiescr bed abova'with an'o her hazardous waste"the total halide goptentts t ESS that t;000,ppni,and the wa;tes7si root ponrW anyMc� •°��� ��
<br /> 0'#1)i have no►mirced'anyof th o i Y, „.. . g
<br /> complied with the requirements of thespplicable California used oil management regutations,to,detarmineth)sas"true:i agree to accept theadditional charges for the.dispoaai of th�t3 wst
<br /> `� if th$'iDtormatlon Ihave provided atieutChia waate'(a incorrect' - : '
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<br /> 2 1 have not Ixed an of the wasto descdbad.abovevith a�ny3oihet ttaFar<iou�waa t'he tofahalf@`cont&nS is;G�tE��fBR th'an 1 b00`ppm,and"th� ata i�oes�o!ojrtafrranq PCBs.t
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<br /> have'provitled props doc4mentatioh'_to Asbury Envitomnantat Sarvicos,to iebut th`a presui mption that;thia`vaate'was mixed w)tti other hazardou9 waste.1 agree to accept the additional charge
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<br /> for the ilfsp4s ;of this waste It the information i`,haye;pr vidad about this waste is incorrect
<br /> E. .. #3 s waste is fro "a�tenk wtitch`ooliecte waste oii'from household do-lt-yourself (DIY)andlo[conditionally exempt srtiall quantity generator(CESQG)sources.fo the best of my
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<br /> knowledge,the only waste oli,contained in my DIY(CESQG collecilon tank ie>ioley from DlYapdror CESQG A.0,rtes�.ihava.not mixed this,weate.oil with any,othorhazardouawaste or
<br /> Nrasteoil from other souraes;l"apr'ea to acceptths additionaicharg0s for dfapoeai'of this waste if the iniorrriatton i have'provided about thin"waste is Inc orrect
<br /> All generators/customs r MUST res .the fotlow>;6 text and check the associated box)
<br /> #4 if 1 am a lar a uantity generator,i certifythat i have a program in pieta to reduce the vofgme and toxicity of waste generated to the degree 1 have determined to be economically
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<br /> practicable_and that l nava"selected the.practicabie;method of treatmen3 storage,or disposal;currentiy available to me'which minimfzes-the present and future threat to'human life and.
<br /> the environrt anN Or,if I am a small quantity.gbherator,l have made a good faith effort to minimlze my waste generation and select tho best waste management method that is available
<br /> t oto€ni-thatl can afford
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<br /> Customera3gnatra a - Rte T !fiver Signature'
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