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<br /> signing below i hereby certify that
<br /> Vtli 1 ) ,�tlWit' .Waste oll. enerator.Icustarn I MUST check 4NE of.the #ollow( ng three boxIli es)
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<br /> t' % iVai$ rtescfli°d�1 o4ewltti no 'Iefhazard`oiiNtase,{h ot1fii5ldcioFifenfl'sLES iesfortdheds osalofthiswasteiftheinformationIhaveprovidedaboutthtswasteisincorr'ect '
<br /> Cllf7) itia�L6 �ioCfii�xetl any ofit l e . Am
<br /> theapplicableCaliforniausedoilmanagementiegulati6nstodete ' Ine this strue. Iagreetoaccepttheadditionalcharg P
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<br /> [�ik2lhavenotmixedanyofthewastedescribedabo fH 11 , Y s� : aKd�> p�gum '%�I • �� hswastewas,mixed itbQyShP,0AZardo % , ILIIt . iagfeeto�acceptthgadllitionalchar14
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<br /> of'thls waste if the information 1 have provided about this waste is incorrect , „ ; ..3
<br /> } . (All generators/ customers MUST read the followof aste ehgI enea 9 dee ihheed kthmine. bem� asSOo omiecadllypaOctkableand that ihave
<br /> a1 e. ua0`titygeneratorlcertifythatlhaveaprograminplacetoreducetheyolumeandt x ty
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<br /> .+ t ` eh stheauthori tobindCustomer, thattheforgotngdescriptionsofwasieandmaterialsaretsonthereverseIttje
<br /> fhis lhdiviifua(signing in the space
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<br /> pa`sl,, i), narkedand9abeled; areiea8yfortransportationinaccordarleewitbapplt6blestateandfederalregulations, arfiithat Customer %shallatiideandbeBoundbythe Standard Terms and Contlitlon
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