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<br /> DIXON OFFICE ASBURY EN1/lRG1NlillENTAL SERVlt� S DBA '11-
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<br /> DRUM EMPTY DRUMS: FACILITY: BSC I.....
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<br /> GENERAL A-'WASTEtCEATIFIw✓ATION(PLEASE CHECK T IE APP.,RO> Rx1,4TI ;I i ) f }' ,`, `,
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<br /> 8y signing below I hereby certify that ,.a a ` *x
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<br /> (Wast oil generator/CustQrrier MU 'T check' =,of theJollowing three bones) zl� .'
<br /> 1 have n't kn xed.a' of the waste described above with any other hazardous, a'sta the?_total halide content is LESS th4t t OOD ppm4.and tha vista boas not contain soy PCBs:1 have ;
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<br /> mpiled°wit t e r„ ulrf"ents of iho adpligspie Cailfornla used qii management reguistions to detarmin6.lbI to Crus (a res to aocept the.... " , " charges for the djsposa)of thisivastg if
<br /> Lha ldfor'rnali n i haO prov�detf apoul this waste,is-1ncorreci' f +. ;,;
<br /> Q s2 Lhave_not mixed any of the waste described above with any other hazardous waste the total haiidecontent is GREATER.then 1 OP ppm,and the:waste does'not contain e�,y PCBs,i
<br /> have provider,proper,documentatign to World Oil Environmental services to rebut the,prasum tion that this waste was,mixed witfi other hazardous waste,fag" fa accept rh®'eddifion'ai
<br /> charges for the disposal ptthts waste if the Informattonl nava provided about this waste is incormct I ` 1:I
<br /> 3 Thiewaste Is fro``a tank which`oollacts waste ol{from household `do-it+yourself(bIY)`andldr condl4lonally exempt smaif quantity gsneratbr{CE�SI�Qj sourcast't`o the°best of my
<br /> owl dge;:the bmly waste oil c"t tatged in'm DIYl.CESQ0 eoliectton tank is,sgiay from OlY and/or CES%12
<br /> G,'sburcest i hayaiiot miXed this yrs§{e ori wi, any o heY hazardous Waate or viaate oil
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<br /> rorri?they aoulrceof 1 agree tozacteept the'aftditlonat charges'for,diisposal of this,waste tf,the infomiattori I have j4royldOo�0 11 I Qup thf waste is InFptt I `'
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<br /> (Ali gerieratorsY customers MUST read the fi illoMn"Illg tee#.
<br /> I certify that I have a program In place to reduce the volume and toxicity of Waste generated to the degree I have determined to be economically practicable and that f have selected ih& $
<br /> practicabie method-0f treatment;storage,or disposal currently available to me which minimizes the present and future threat to httrrian life and thagttviroumenL
<br /> This Individual atgning In the space set forth,beiow on bBhall of cpstomer represents and warrants that he/she has the Authority to bind custbmar,thsi the forgoing descriptions of waste °
<br /> and materials are true and accurate as pagitpgad,marked,and rebated,are Ceady.for transportation in accoYdahca wtthapplioabfe r;refs egtl fodaral rataulations,and that auetomar shall abide
<br /> by the Standard Terme and Conditions on�tlie reverse aide of this Service Order,
<br /> Service Orders with an:associatad hazardous waste mantfest telther sit.specific or consolidated)are subtect to an EPA Pee.Thesetaes cover the EPA pass-through fee and admiotatration
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<br /> ' gram. These fess vary based on Manifest type.Applicable fees will appear oyi your billing Involce. '
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