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<br /> AIA RI POSAL INFORMATION
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<br /> DESIGNA '»
<br /> AffERNATEr�DFd13�iF,n�o�+'.aa,arc�tt� it r +yx:ai►.. ri,'var it..,.,,:.1}:. :'1: t._ + x�c. it tey:t y c Lx it7>.
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<br /> DRUMS PIU: AP..TY DRUMS: , FACILITY:_ BSC Y"
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<br /> G•EW R'ATOR WA$TE 4!ER'F`iFIfATIdN,(PLEASE CHECK'THE`APPROPRIATEIIOATR
<br /> Ely srgntng below I hereby atrtity.that: "*
<br /> is
<br /> (Waste oil generator/customer MUST check ONE of the following three boxes)
<br /> 0 11)1 have not mixed any of the waste described above with any other hazardous wasto,the total)halide content Is LESS than 1,000 ppm,and"waste does not conteln star PCBs.I hmrgr
<br /> compiled with the requirements of the appticebIq California,used oil management regulations to determine this Is true.I agree to accept the additional ehsrges tor,tho die
<br /> {roaal of this waste It
<br /> the lnlamTatlon i have provided about this waste In Incorrect
<br /> �] #21 have not mixed any of the waste described above with any other hazardous waste,the total hatldo content is GREATER than 1,000 ppm,and the waste does not contain any PCBs.1
<br /> have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste,l agree to aec epl.the sddillonal
<br /> charges for the disposal of thele waste if the information I have provided about this waste Is Incorrect
<br /> Q ,C3)Tina waits Is from a tiitk>vft"' a Oicts waste oll from household`do-ll-yoursett"(OIY)endVor condiuotiaUy exempt small qusnUty generator(CESfiO);eouresi,lb the bsBt OI my
<br /> knowledgges,tlt�oltyriteoE cOnf1 of my DIY!CESOQ colleatlon tank is coley from i)IY end/oir'CESOb sources:)have'not�ttixei'thla waste bit with any ot}i§r harm does waste at,waste o0
<br /> from cthe}so} egi6!-a' io ioee�rt the i ilditlonal charges for disposaf of this waste If the informAlon I Have provided eboutthis waste Is IncorrW
<br /> (All generators/customers MUST read the following text
<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 practicablo and that I hove falaatsd t ltti
<br /> pmcticabfe method of treatment,atom e,or disposal currently available tome which minimizes the present and future threat to human life and thee ironment. i
<br /> This individual slgRlrtg in the space set forth below on behalf of customer represents and warrants that he/she has the authorityto bind custo t 1 the folgotrtg desorption•,of wa
<br /> ials
<br /> and mafars are true and accurate as pscksgod;meu*ed,and labeled,aro reedy for transportation In accordance with applicable state and I Mations,'and that customer shall abide
<br /> by the Standard Terms and Conditions on the reverse side of this Service Order.
<br /> Service Orders with an associated hazardous waste manifest(either site epeclfle or consolidated)are subject to an EPA Fee. These fees or EPA pass-through hes and administration
<br /> of tho eManifest program. There fees vary based on Manifest type. Appllcabla fees will appear on your billing invoice.
<br /> ry VJ
<br /> tamer SignatureaD to Driver Sig re Datta
<br /> Print Name - Print Driver Name
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