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<br /> NON ttCRA 1 IAZARDOUS WASTE,L(Qll1D(t1SEp OILIMIED O1LS} S TAtF BODE X21
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<br /> NON RCRA NAZARDOI7S WASTE,LIQUID{ETyYLENE GLYCOL SQLUTIONS} STATE CODE1. 'S t '
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<br /> pRUMS RFU ' = EMPTX gRk1MS FACILITY < fi � 8SC = "t* i xu
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<br /> :GENERATOR WASTE CERTIFICATION,(PLEASKHECKTHE APPROPRIATE BOX)
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<br /> By signing 6 Iiov,I hereby certify that
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<br /> 11-1 i i i4 (Waste ofI c enoratorI ;tomeriMUSt check.ONE of therfollow)ng three boxes #
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<br /> #t)I have not mixed any of the' a-i3descnbed aboye with any othprhazardnouswaste,the total halide co6iehi is LESS than t,boo ppm,and the waste d3oes not co stain anypCBs.i have complied with the iequiretnents,of -
<br /> , e apppcable Caiifomia j%sed otl management regulations to tletermme this is true.1 agree to accept the'addiiional charges forthe disposal of this,w,as[e if the informatiori t have provided abputthis waste Is)ncoriect
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<br /> `O#21 have hot mixed any of the waste descr bed above any other hazardous waste the total halide content is GBEATER`than 1,000 ppm and the waste does not contain any PCBs,I .
<br /> r `Vir ent I ervices to a esurp do'ntha`ihiswaste,wasmizedsyithpt eriazardous;waste.i gee toaccettheadditiohalchar esfo, djspr}sa�pfthi;i .
<br /> have proyidgd proper dotympntabog toLyQ)r!Otl Eg onm„a 5 t Ut At P t f2. 1 (. P 3
<br /> Wasteifihpinformatioglpaveprgrtdedabout" "',asteisinr4rrect i y:ii( , +r, a
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<br /> a`” d"--oursei'DlY ani//orcOnifitionalfi ezen`t'r-A u''i"'"enerator'(CESQGhour'ces,Toihebe3tofr yk66iriedgextheonlywaiteolicontalned
<br /> p#3) is LVa3te i;frog�n?a tank ihlc collects waste oil from bouS$hold, o,it Y f t; ) Y, _ p 4, Y 9
<br /> !in my D1Yl[CE54f colleetidii Iaiik 6Tey front DIY andlot'CC$QG sdifkes.'I have not mixed this waste oilwttti any other hazprdous dras'te of waste°oil from other soa?c`es,i agree to'a-,,,.- headditio'nal cha tl8fordisposal
<br /> of this waste irihe informa1.tion l1.have provided about this waste is incorrect.
<br /> (All generators/customers�MUST.read the following text and check the'associated`b&o " `'l `€ '<"I
<br /> 4)III an)a large uantit generator,I certify that I have a program place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have
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<br /> selected the`ractitabipmeth"od'oftieatinent;'storageISYdisposalcurtentiyavaifabl'etometiVhichminimizesthepresentandfutbretht'eattohumanlife`andtheenwronMen'ttor,ifiamasnlallquanhtygenetatotI ')Ii
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<br /> 'have p ode a'goodfaithbi#ort i6 i`inimPze my wane generation and seipti the bestPraste management method thatis available to methat l tan afford ° ' " ' ' ''x f '
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<br /> "n''ac"tuPate
<br /> This individual signing in the i acc set forth below on behalf of Customer represents and warrants that he/she�has the authority to bind Custom atthe ,rgoing descriptions'of waste and materials°are true a d
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<br /> as packagedimarked And labeled,are ready for transportation in accordahCo with applicable state and federal regulations,and that Customer ail abid nd be��wsand Terms and Conditions on the reverse
<br /> , side of.this Service MO. t': : .. ,
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<br /> C stome Si" tur Date FCverSignature` Date -''
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<br /> Print Name Print Drivers Na'm
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