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<br /> ENVIRUNMENTAI� SER.VICE ;�
<br /> s 14287 EASTMANNING ;AVE; PARLIER CA 93648 EA t BAY TIRE - EASM
<br /> H EAST BAY TIRE COMP 'W : 1 s59,498 0240
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<br /> FT StC}Cd{TC7N , 'GA �D2i 5 ' TRANSPORTER EPA # CAD028277036 FAIfFIE! ! �% "CA X4533
<br /> b" (20I) 8SM701 (7{371 =5t3i3
<br /> CUSTOMER # PURCHASE ORDER # ROUTE,# ' TRUCK # CONTACT NAME ORDERTAKEN BY ` HALIDES
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<br /> DATE REQUIRED DATE ENTERED NEXT SERVICE ATE CUSTOMER EPA # BILL of LADING/MANIFEST #
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<br /> PAkT # - � � DESCRIPTION ` QTY ` UNIT P_RICE , �;QT�! PN, ' , TOTAL
<br /> AF ; ET�4YL '=NE GLY . SQ��l �# `I All �
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<br /> WASTE DISPOSAL INFORMATION
<br /> NON RCRA HAZARDAVIV
<br /> OUS WASTE, LIQUID (USED OIUMIXED OILS) STATE CODE 221 133
<br /> NON -RCRA HAZARDOUS WASTE, LIQUID (ETHYLENE GLYCOL SOLUTIONS) STATE CODE
<br /> OTHER: IV IF
<br /> DESIGNATED TSDF: - - � `asf $i �, :. `€ D '`r A F-IW23 CA i
<br /> ALTERNATETSDF:
<br /> 4 DRUMS P/U : EMPTY DRUMS: FACILITY:
<br /> 11 1 WWII I III III III MINIM I
<br /> GENERATOR WASTE CERTIFICATION ( PLEASE CHECKTHE APPROPRIATE BOX) •
<br /> By signing below I hereby certify that
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<br /> ( Waste oil generator/customer MUST' check ONE of the following three boxes)
<br /> Il�� I have not mixed any of the waste described above with any ocher hazardous waste, the total halide content is LESSde additional chanes for thhan e disposal of m, and he waste waste if ties n
<br /> the information I havt contain any e provided ve obou't his waste sed with the encorree�nts of
<br /> ; the applicable California used oil management regulations to determine this is true.. ) agree to accept t 9
<br /> Y3,"OVA 1 have not mixed any of the waste described above with any other hazardous waste, the rota! halide content is GREATER than 1 ,000 ppm, and the waste'doez not contain any PCBs. l
<br /> haye provided proper documentation m Word Oil Environmental5ervices to rebut the presumption that thiswaste was mixed with other hazardous waste. I agree to accept the additional charges for the dispaal of this
<br /> waste if the information I have provided about this waste is incorrect
<br /> n ` ` ank which coliacts waste oil'frori household 'do--it-yourself' (II and/or conditionally exempt small quantity generator (CESQG) sources. To the gest of my kr .a 'Iedg^, the only waste cit contained
<br /> 7 33T1t=s waste is from a t
<br /> in my DIY/ CE.0 collection tank is coley from DIY and/or CEQG sources: i have not mixed this waste oil with ahy other hazardous :waste or waste oil from other sources, l agree to accept the addit+en ! charges fir disposal
<br /> ++� of this waste if the Information I have provided about this waste is incorrect
<br /> (All generators/ custorners MUST react the following text an
<br /> check the associated box.)
<br /> " y •^, nim I hawse n ;i*ir trots if) r+l• < ,. it)wSint e lir• v+ries v �nri hr>,i:it ) rf yfmte, kerseratec! ca ifrr du4r=�' I h,svo d^irtrn nr 3 t � f:+� ,,ronurnitJliy Ht stta�lc and that I have
<br /> r 'rtl malar?TC �r rirt} g^r•�r�t •r. t , . �rlty . tt y^ }
<br /> i t s -rar;4 fit1lr. nrc;hotf rf incF_ +,nr, Storage, or:di5pc5ai tirtient)/ as ;t3laLi to m , v .ti ft tnUtltnfresTit4 rt,ts r t n3 future= thT«at to iilittt ,r lite an l their}'nroirptcnc: Qr, tE 3"am sn,,,ll qu nt, yn^nor. +nr, t
<br /> F ;;., h x : to:s r, tfi faith ett r ! to minirritza m yr ste rienntabuu and seficct th best taste mari;i, <rnr,ni tnekb :i th„t i4 «ilsisio to ire Ch:tSl z n +;.turd.
<br /> This individual signing in the space set forth below on behalf of Customer represents and warrants that he/she has the authority [o bind Customer, that the forgoing descriptions of waste and nwicriaL are tri _ and accurate
<br /> as packanati, marked and labeled, are ready ” transportation in accordance with applicable state and federal regulations, and that Custnrner shall abide and be bound by .he Standard P rms and Cond:tiw s un. tiro rel. ^ee
<br /> side of this Service Order.
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<br /> IVwVAP
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<br /> ' ' i Date Driver SI nature
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<br /> Custorner Signature
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<br /> All.
<br /> Print Name Print Drivers Name
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