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<br /> CA "r' "' . TRANSPORTEREPA # CAD028277036 " ' „ '� � ' .
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<br /> CUSTOMER # PURCHASE ORDER # ROUTE # TRUCK # CONTACT NAME ORDER TAKEN BY HALIDES
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<br /> DATE REQUIRED DATE ENTERED_ NEXT SERVICE DATE CUSTOMER EPA # BILL of LADING/MANIFEST15 11
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<br /> NON-RCRA HA7ARDOUS WASTE, LIQUID (USED OILIM4IAN W D OiLS) STATE CODE 221 '
<br /> NON-RCRA HAZARDOUS WAS7E, LIQUID (ETHYLENE GLYCOL Pee
<br /> SOLUTIONS) STATE CODE " J i
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<br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECKTHE APPROPRIATE `BOX)
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<br /> i41 ed " bovewithan otnethaz5rdouswaste; thefataltialideconteitCslfs$Sfhap1,A0ippm;andthe"waste does not contain anyPCBs;Ihavecompliedwiththe;regulremele IN , ijts'gf
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<br /> 4 " the applicable California used oil management regulations to determine this is true, i agreeto atceptthe additionalcnarges,forthe disposal dithiswaste if the Information I have provided about this waste Is Incorrect
<br /> p#21 have not mixed any of the waste descdbed`above with any other hazardous waste, the total halide content is GREATER than 1,000`ppm, and the waste does not contain any PC8s. I
<br /> Leehave pipyIded pfopefdocufiegtailon tQ"1Nodilld qIIIiL> nviropmenialservices to rebut the presumptq.ion t(tat ih)s waste was mixes) with other hazardous waste. ) agree to accept the additional charges for the disposal oithis ..
<br /> wasteif the inf0jmatipni hive provided about this waste hincorrect
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<br /> `: alar e'quantity` aeraP-Mtor-lcerti thatlhavea ro ram npla'tet4red'ucethevoiumeandtoxici of"wasuegeneratedto the degreeIhavedeterminedtobeeconomicallypracticableandthatIhave "
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<br /> as packaged, marked and labeled, are ready,fortiansportatlon in accordance with applicable state and federal regulations, and that Customer shall ab�nd be bound by the Standard Terms and Conditions on the reverse
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