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DO <br /> OTY PN <br /> I <br /> TO— <br /> CASH RECD: HECK a TOTgL <br /> WASTE DISPOSAL INFORMATION <br /> NONRCBq rygZgqoO US WASTE.LIOUID(USED OATH)%EO OILS) <br /> US WgSTE.LIOUID(ETHYLENE GLYCOL SOLUTIONS) TE CODE 321 <br /> l DESIGNATED TSDE STATE ODE <br /> ALTERNATE TSDE: <br /> DRUMS P/U:__ ... <br /> EMPTYORUMS:__ FACILITY: <br /> BSC <br /> h__.__.GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> (Waste oil / <br /> generatorcustomer MUST <br /> check ONE of the following three bows <br /> "' ewuimbw..0 r.�:,.,,,«I o«n.m.�.n«.m..�.,mm.�nl.r.�,. w«m ..gym>.°°uro.•I v..�.,.n°.w.u.��.�,....n <br /> .aNrn «......... <br /> ....�.n m.mr.,m.��..ln a�.Iaa.i>o,„Inr..«..I.m=.�,«I ml...n....ma.°„n".m..n...�°,..,.•.I v+.m..wl�««an�,,.� <br /> generaomerslMUST read the f011OWing text <br /> mmwluu :a°M°n««.w."nalPo o�°'^:`n%I.V.sllom.,,..• .avol�.v u'"°'"",e.n..n...�n.ne�.l::° .v..I.n«...a <br /> u.c..ErgT«cT <br /> - n«. Pwk."�erw„m•PP«,e.r=n, ,e m.dE h... v.P.., <br /> a...I” a"I«.,.wml.Lv.n.. <br /> �E.A <br /> nmure l — wn <br /> Data <br /> ��,; Driver Signature <br /> Data <br /> Print Driver Nema <br /> hw�. <br />