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<br /> DATE REQUIRED- DATE EN HERD' N)rXT.S.ERYICE DATE" CUSTCII�ER EPA# MANIF S
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<br /> PIEASECII:CkTHAPPRR1�41SOX ''gi ` e- # �i fit':.'
<br /> :This is to certify that the waste deacdbed above is properly classified;described,packaged marked and labeled,'m Is Ircpropercontlitioniortransportation,according to'appl(cable State
<br /> and federal regulations.Bysjgnln belowtaisohereb ,certifythaL; tr _ t -
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<br /> #+,+ �4llenerarjtreMtS �� EftfWfQllowingbosqqq)4 r .�_ ��e u
<br /> as a escr#'etl above with an'`other hazardous waste;atle Lotal.telidecontQnf is t ESStha�1;000.ppm,'and She waste dod t cpriyPCQs)1� ye.�t 1
<br /> #1l 1 have not`mixed any'of thew t d b y
<br /> compliedwith the requirements of the'appucable California usetl.oil,management regut'atipns to determine tFii$.is:true:`i agree,to accept the additional charges:-o I he didposa►.of this wastd
<br /> If the information 1 have provided about
<br /> this,Waite is incorrect
<br /> s< t�yT;[[' T'ra; # 's L s a r 00't hi alid.the i ate tloes no contain an PCBs fv
<br /> a#2)1 have not mixed any of the waste described abgvarw th any b he hazardouswas a,,the total fialitle content is RF1►Tf t tit , pp.., Y
<br /> haveiproyided propg6documentation`to Asbury Environmental Services to rebut the presuiiiptlon that this waste was mixed With other!hatardous waste;"1'agree to accept the ad`dltional charges
<br /> for the disposal of this wastwif the information i have previded'ibout thli waste Is incorrect '
<br /> 0
<br /> 83 This waste is from a tank'which cohecta Waste oil,trom household"tlo-it-yourself i(DIY)andlor"con�tionally exempt small quantity generator(CES'QG)sources:To'the best of my'
<br /> knowledge,the gniy waate`oiPcontained in my DIYi.CESOy coiiection tank is'sotey from,DlYandlor,t;6'4.sources t have riot mixed this waste ell with arty otfier hazardous waste or
<br /> waste oil from'9ther sources.l agreeto accept ttieadtl(tior aichergas for disposal of this waste it the in@rmatiori I have'pro4idatl about this waste.is incorrect
<br /> (Al1 generatorsJcustomers NtUST ready the following text and check the associated box.)
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<br /> if I am a'aarge usntity'generator,l certify have a progrem,in�Place tq reduce the t'010me and toxiClty of waste generated to the degree i haye,'determined to ba economically
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<br /> gdpabie and that i fi vs selected the practicable method oCtreatntentrstorage or dI'sposaticulrentiy.;availabie to_nia which minimlaes tt)e prgsent dhs!future threatto human Ilte and
<br /> th 'nvironmertt;Or AF,(am a smalLquintity generator,I h8ve made a good faith effort to minimize my waste generation and seiecEti a tie' waste mabagement method that is available J
<br /> to me that i can�aN
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<br /> Customer.Stgnat�re Date prlvgt S 9, :.Date ;
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