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AN j ii ORDER;
<br /> fOR SERVICE` GALLANN AN ,A
<br /> FAAIIIIt FORM NO: ViES004 B
<br /> DIXO U O MCC ASBURY EA.N1/IR©>1 lilIENTAL SERVICES, DSFAA ANN
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<br /> NQN-RCRA HAZARDOUS WASTE,'LIQUID� BUSED Oi A le IN IXED OiIS) I STATE CODE 221A A-
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<br /> X. NON—RCRA HAZARDOUS-WASTE, LIQUID {A AN ETHYLENE GLYCOL'SOLUTIONS)1 I STATE CODE , ,w TfAA
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<br /> GENERATORINASTE CERTIFICATION (PLEASE CHECKTHE APPROPRIATE BOX) If `ll lef";_,
<br /> 9y signing below Ihereby certify thatTieIN y
<br /> t {Waste oil generatpr/customer MUST check I 9. QNE of the foilowing three boxes) �%
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<br /> {. Ltpt)'i;;havenotmizedanyofthewa§tedsscrlbedabovewltlianyAtherhazardo3swaste, tttetotalhallderoritenlistE55than1,0900ppm, andthewastedoesnotcontainanyPCBs ) havecompliedw(ththerequiremertt of ry01
<br /> the applicableCaliforniausedoilmanagementregulationstodetermine`thisistrue, Iagreetoaccepttheaddition�alchargesford dispgsalgfthiswasteiftheinformationIhaveprovidedaboutthiswasteislncorrI � . TI
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<br /> ` Q#21 havenotmizedanyofthewastedescribedabovewithanygtfieihazardouswatste, thetoSalfi A % , 1, I I AisA gWeEftI ' llthanl 000ppm, andthewaA.stedogsnotcontainanyPCBs. i E.,
<br /> have provided pfoper., wI gumentallon t4.W,o d.Oli Environmental 5ervke's to rebut3he pre"IIsumptibn that thl3 waste'tvas mlx1.edAt'h other haiardous waslga ageee to accept the additional charges for therlisposal ofthis
<br /> Waste fth¢ infoA I Itlonthave,providedaboutthiswasteis )ncotrect11 a „s
<br /> }AN" , - 'a . s , _,, _ a i'., c% nta n " d tom,..-)
<br /> hi c' le east s e oil ' ` "`h ' ` "o d o it 'ou[self IDIy) ariii/ortondiiionall exempt shall 'uanti ,gErteratotiCES(�G)sggprces Tgthe best p my ftnowled.4e the only }y3ste oANNil o , , I .$
<br /> dif3) Is wasfe. I a ftw ch, , olI CT Ter III , ,. fr4m ctk it „) d . Y, , . .y . ,.9 ,t? w,,, . . x,
<br /> ' (n my lY� �� A A6lle6tjot>aWtanftl'ssoley-fiomDlvagd/orCESQ sourest; lh�avenotmixedthisWasteoil"withanyo[Fe� hazardou wasteorwaste'oilftbmQlhersources. lagreeioaccepttheaddittoria1char� s {grcJisI%vpofal1 fief
<br /> ` of thiswa"steiftheljeele
<br /> nforFAA "mation have provided about this waste is incorrectNetNet '?
<br /> P (AN 9 All generators/ customAN,ers`AVMVAN UF-AST read� the following teXt and check the associatI AN ANed 6ox:� x
<br /> I qua ` " a "ds " t Ihav a [ ra[r in laceto �ed"u et `e `Q)tiijte dtgxI I Pfvta` ?s, enA fesltot 'd, reglhayedeterminedto.beeconomicall practicable and that .
<br /> r 114)Iflama argeg , _tity rier, tor ertlfy that . - .. s pQ9, : _ . P - . �, ,, . < A„9r t. t 3 „ 4, ,- +, . ' ' AN
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<br /> r, . ect the c cab a me ho oftre5t" ' h stofa " oY fs" bsa) Urreh l' avatlab e to m Ch m)n iz lhe, re $n a tore ihrgaaal :t manlife, and the environment br if i am a 3ma(tyua{rtitj generator, Li
<br /> , sel ed Pia. I Allfls_�IJ , rt?g y 9� d FellAFIAT, tANN Fi „ ITT
<br /> haverrladeagoodfatthefforttominrrlizem� Wa)jeANNg€neratiknandselectthe_IJybeslwastema getn $ eI odth t`tsay 60 TV FI4anaf(grd. " " ANN
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<br /> u I signing i ' esacesetforthbelowonbehaifofCustomerre resents and Warrants that be/she has theauthoiity2obindCustbmer, thattheforgoingdescriptionsofwasteandmaterialsargtruearidacc�1. I
<br /> " 7)iisindivid a s, g ng nth p represents
<br /> ; as packaged, marked and labeled, are ready fortranspartatloo in accordance with appikable state and federal regulations, andthat Custg7nei hall abide and be bound by the StandardTerms and Conditions qn the reverseI Of I'lIN
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