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94/23/2015 THU 10: 38 PAX <br /> • REGEA Y E� ®001/001 <br /> APR 3 0 2015 <br /> 11855 MR R ROCK ROAD Dalen,1^:vcnt: A rll 29 2015 <br /> RANCHO CORDOVA,CA 95742 '!Sara am <br /> .(916)351-078() ENVIRONMENTAL ,,,fat:acd: - -,- <br /> aNvlaoNOHN'L SBRWCBs ,,�CA�TU nCDaRT!�ICt�T.fimes Participate d• ��^ '•'� <br /> \4uxm aa74w <br /> CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR'WASTE <br /> CHECK-IN RECEIPT AND CERTIFICATION STATEMENT <br /> ^—^ TO RE COMPLETED RY CENIL'17ATOR: <br /> I certify that the following htformation is correct,and I have read and understand the roquiroments for participation in the Philip <br /> Transportation and Remediation Inc.Conditionally Exempt Small Quantity Generator Waste Acceptauce Progrmn. I further certify that I <br /> am a Conditionally Exempt Small Quantity Generator as defined by Federal and Califorula State regulations, and tws quantity of waste <br /> does not exceed the specified limits for the type of waste koiag disposed. If this waste is lator found to exceed small quantity limits or <br /> contain mutoriaisnotaccepted.underthisprogram,Iagreetocomplete.a.hazardous.wastomanifestatd.romplywith othelitaterogulatious.....- t <br /> as appropriate. <br /> COMPANY NAME: Gemco Ripon Truck Plaza Inc. CONIPANYRM Harjit JohI. .... _ <br /> COMPANYADDRESS: 1022 Frontage Rd EPA IM SAI.. 0nnrAQ7nq r� -- ! <br /> CITY,STATE,ZIP; Ripon, CA,95366 _ SIGNATURE: _ <br /> COMPANY PIIONE: (209) 456-7474 TITM . - DATE: <br /> To Ill Compi xuPn BY PHILIP .... <br /> TRANSPOKI'A11ON REMFD)iATION CFIF,CK-INATTENDANT <br /> OBiJERAL WASfB DfiSCR1M70NIiALAau All :STATE sl' ' ROP 'COIdTAIlQBR wMSIR WT(LB) D1SP. C09T I <br /> Ct.A,9S.. w Sl �CON3 t.:�: MNT 1'Y. IZG .rAM tl' 1: „ METH ••^ + <br /> Mi y.Absorbant _2• 5 a 114.4 09.72 <br /> •Y . <br /> 1S.ssina Fee -- �20- <br /> MF.TIIUDOI'PAYMtsN't: CASH cI-IDscx. (JIPCKNO, t � .,l ToTALPAw.a 129.72___.-......_ <br /> PI-IILIPTRANS&.RHMEDCHECK-WATTENDANT9INITIALS . DATE <br /> rso.eoi My Oen: CHECK-IN RECRIPT <br />