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<br /> s L'6l FCR$,;iPtO.VVOE5004-B {;/L71
<br /> SFRIVICE CRDEF MO.
<br /> FOR A000�7V77FVGCALL: I11
<br /> 502-231-1550
<br /> ltit4.•ff,�Nt-,iE N.— L SrER V ICE-S•w
<br /> 7300 CHEVR01, YYA1`,Dl;;OPI CA 95620
<br /> 1-6-0-7 -2379
<br /> :'�1(ANJ.!�rORLDafLcaCP.Cara
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<br /> 7 I _ TRANSPORTER EP/0 CA.Dn283 77036
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<br /> OUST=+iirZER URC1 iASEORL�ES r yOUT: ; TRU
<br /> C%111AC'.T NAMFE jy ORDER Tal<Er!31'
<br /> {DATE n^_EOUIRED
<br /> r DATE ZVE.,-f.,D NEXT SERVICE D9fE� CU7JiI 31L_e.f_ADILG
<br /> TA?MtFESl'li j
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<br /> -RA 'i...._i_. !.?ESCRi?TIOh4 i Of'i U�`.(TF!?IrS�` {� ✓b/�; f TOTAL
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<br /> ��Y. ._.::�.:�.:.::� ..�::..•.�,::w_.::,=—•-, -'--�-•---:•;�--•:.•.:a...,.�.;-,..r.:!�..._:.._.:.._.,- -t_- ......-..•-. 11`.=TAS. .�, ':.•....,.
<br /> )CASH R°C'D- CHECK. ,. �..:•,.••
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<br /> WASTE D SPOSAL IN.ORMA.TION
<br /> NON-RCRA HAZARDOUS VdA57f,LIQUID(USED OVA41i;ED OILS) S ATE COVE 221
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<br /> XON-RCRk HAZARDOUS I`dF',S-f£,LIQUID(ETF?''LENE GLYCOL SaLUT(Ot`15` STATE COD
<br /> OTHER c +�ti: met: ."_ '•,ac':�c:,• — y
<br /> y i DESIGNATMTSM: --
<br /> 9 H JERNATE TSDF:
<br /> DRUMS PTiI: EAAPT"DRUMS: FACILITY:
<br /> C;ENERATOR'tAfASTE CERTIFICMON(PLEASE CHECKTHE APPROPRIATE 60X)
<br /> �'511J't'1fj bEldtY!11M2by CErtlff that:
<br /> (Waste oil generatorlcsstonier MUST check ONE of ihe'rollowrinq three boxes)
<br /> 1=17"lLao:no1r,IzoCcnyo'ihi•n;stedescribed absver•ifhai)yo;t,r•Ikiratcatis^aac,t trtalhtid r--t.ncisLr ll-an1,03*ppm,and thems—,da,re_anrairai;y ;.?hav_crnrptirfxithtt,r:Nu;an:nttof
<br /> thuap;sbca�lt•r:sii`crni:uscdd m.utagemait;rcr-.dnionstodommippIM,
<br /> atru !acreF:astrap d>:=ddttataiciwm�sFmthed:=posatoftla::as[c1` mrmtnmionlhartpnrdevs�Ioti:tiv;wasttisrrorrect
<br /> :�•:'21 ha•mt mer,:;;srtucd-1,,xt:va5u watun fia>,rdw•s twste.ti.n:o;aI hdide:coma:i--GREAlU thin I.Oo ppm a,:d the nct com-An o c3;,l
<br /> b u-c—ded proper dock notatin'.to%Xuld(Yi Errvirc r man(a;'Fw"oL;:o Ki)ut tile Ixes-,Iwtlon ti:a:eJ)h w.t=te w1'r;MOL"I v.01 a:her I aae::a t•r.cept thy:adrAf korai charges`ot the dispcse.of This
<br /> •r:asfa.i th:;uderd�Gon I itatr pwritad Jx:u t:rs�::ste s ireotn:ct
<br /> Ms3)7his'wastaif.:roma tankr,hichco,e(ts•.aasteoi4fromi)ixuehold'oo-it•vnulsalf`(bil'Iand:orcantitiaivlW-n"r pt small quantitygv^nerre1:Ct.SOGI5axc.Ynthebtstawgkninv!ed,teatheonlywas!o4:corcaiced
<br /> in my Me CGSOG catuction mak is son MY an
<br /> lry Invo;or, CES;7G soures.3 hav,,ncL miA=this::ante oil wpb amodic r mmonious wac: wastom
<br /> e or waste oi!! =t,It:souses.I aci'ec..)accept the xddiUo•taf char9m:or 41:* sal
<br /> c tLis•:race if Uto infornatinn I hm-e crrwidett abaac this was.o is Inc--re--.
<br /> (All generators/customers MUST react the fbilowing text and check the associated box.)
<br /> if 1 am a la,ge roand ty 9cmetaror•1 coni h'Thal I have a wagram ir p!acv to redrxe Aw toiumo an;.:„ir by of wa!:e ytrecrxer'tn Thr JLII,--*:have Bete-1,M V+d to ce-connmicaly p*uica!•le and if at t fiat,2
<br /> selrctrd the przc;i:ahle inethod ei iree:nx no,stnrag..o:dispesat can:nU J"!a:!e tc mi awhit.h mininszr the prece nand hrum threat to humin wm aid Ute ereArovirrunt;or.if l N n a crnaif ipxnf fy per-141c,"1
<br /> haw nude a good fifth effur,so mhumia•Trn waste tern::-:Pon and sekra the nest ra:w-to i)agewenunctwd L')at is availa's!e to me,Uwf I can e4ford.
<br /> ;fus :n*-'pine set rxth h:sar.nn h>.'vik'o(riistunx wptclunn and sva:ran;s that he:she ha-Tho autban t;•to bktd Custoaset.that:he:argcing dosniptlons of:vaste and tntro;ia!s N a tr.rc and=..law
<br /> atpad:at!ad.ma.Iwct4ndinhaled,are renilyfar t7.rsl:ciV.0oninmca..il,uieek•:itl) ticamesU;carylktdwr, Ireguth,iors,andd;:.ICustornnrsi:arrauideantlbeboundbyUteS:'.nNidre! and Cot xihiens:Mthanever•¢
<br /> S:d•'o:f!%$CNtr.c()rdcr.
<br /> 7.
<br /> _ I
<br /> Customer Sigliature Date ;. Driver Signature "`'""� Date
<br /> Print Name Print Drivers Name
<br /> Z'd est:L L '9L 0 100
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