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<br />TRANSPORTER•EPA # CAD028277036 . t_ 1t +floods 'I ow
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<br />DATE REQUIRED, DATE ENTERED:.:.:'. NEXTSERVICE DATE.. CUSTOMER EPA # B1LL of LADING/MANIFEST#:
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<br />WASTE DISPO5 •
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<br />F.NON=RCRA•HAZARDOUS:WASTE,:i jQUID (USED OIC/MIXED:01L5}..; _,'`&:; ..'
<br />4. IF 4, IFsTATECODE 221 ::: :..::.
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<br />NON RCRA HAZARDOUS'V[WASTE; LIQUID{ETHYLENE.GLYCOI SOLUTICiNS}` STATE CODE: "'b.do.< .. .IF L
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<br />DF. RUMS P1U:'` r"./r �rG, r`' FIL: • ' EMPTY DRUMS: FACILITY: BSCILL
<br />GENERATORLWASTE CERTIFICATION (PLEASE CHECK•THE APPROPRIATE SOX)..,.. , .
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<br />IF IF
<br />8ysigningbelow therebycenlfythat:,., ..•.
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<br />Waste oil" erierator/customer:MUST cheek ONE ofthe-folfowirig three( oxes) =:. IF, IF.I ": :
<br />{� 11) I have not mixed any of the waste describe_ d above with any otthei hazardous waste, the total halide content is LESS than 1,000 pRm, and the waste ILL.. Idoes not contain any PCBs. i have compiled with the requirements of
<br />the applicable California used oil management regulations to determine this is true: l agree tc accept the additlonal charges for the disposal of this waste lithe information l have provided about this waste 15 incorroW
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<br />1� A21 have not mixed `any of the waste described above with any other hazardous waste, the'total halide content is GREATER than 1,000 ppm, and the waste does not contain any PCBs, i '
<br />have provided proper documentation to World Oil Environmental Servicei to rebild presumption that this waste was mixed with other hazardous waste,l agree to accept the additional charges for the disposal of this
<br />waste if the information l have provided about this waste is incorrect IF
<br />FILL7tr3jTlitstvstels'frtankwhicFicolleI. ctswasteoilfromhousehold do•i�•yourself'(01Y)and/or conditionally exempt small quantity generator(CESQG)sources.Tothebestofmyknowledge,theonlywasteoitcontatned
<br />aoma.
<br />In my DIY/ CESQG, COIIeC1I017 Tank Is f01ey from DIY and/or CESOG.iources.I have not mixed this waste all with any other hazardous waste or waste oil from other sourcesa agree to accept the additional charges for disposal ..
<br />of this waste if the information 1 have provided about this waste li Incorrect FILL IF I
<br />IF
<br />(All generators Low. I
<br />/customers MUST read the following text and cheek the associated: box:):; .
<br />M AIF 4) fill am a large quantity generator, I certify that 1 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 I have'
<br />�iselected the practicable method of treatment, storage, or disposal currently available tome which minimizes the present and future threat to human life and the environment; Or, if i am at small quantity generator, l
<br />have made a good faith effort to minimize my.waste generation and select the best waste mFILLanagement method that is available tome that 1 can afford.
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<br />IF
<br />IF
<br />.,This lrtdividualjl9nhiq iLt IF I L
<br />n the'spaceset forth'betow on behaf f of Customer represents and warrants that he/she hat the authority.tolilriiJ Customs ; that the fo'rgoing descrlptlons of waIF Iste and rriaterfals are true and accurate
<br />•"'as.pack1jed mar�dindlabeled, arereadyfortransportation Inaccordance with applicable state and federal regulations, and that Customeot ishallabldeandfieboundbytMe.Fit
<br />StandardTermsandConditionsonthereverse
<br />side of thisSice Order.
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<br />r' '' Date Driver Signatfi're,1. Date
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