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Dec 30 2013 7:16PM HP Fax • page 3 <br /> RECEIVE ; <br /> i 191 ,RP>9LRt41R� - . - D oEvent: j _1 g`l'13 �R <br /> � SA 9s5xx DcC 3 0 2013 Time:En formed: <br /> b: a <br /> ENVIRONMENT P ted <br /> drir:a.rq, - HEAI-TH DEPARTMENT ` <br /> COMMONALLY'$:f Ei1 T WALL QUANTITY GENE.tATO#WASTE <br /> G' IN M MOTAND CERTIFICATION STA <br /> TQ $CQMPL ETED;EY G1fTVERATOtt <br /> _ 4 <br /> T 4vdfY 16at!}ip�oUoauimB3uScrtge4ott is cwoctP and T have read and understand the for parti 'pa ion in the Philip <br /> Tiat€apoa 400 and ltoeaediation Imb,Condiumany U"Upt'Smail Quantity Generator Waste A Do Program further cerdfy,thai I <br /> Ob*ConditiomH ,ftempt SmMU Quantity.Cmnerator.as defined by Federal and California StE to re ions,and t do-quern*of X'aitte. <br /> AoaamolwcctmdtbPaPaw dlimitgfrormo ofwas4ebele " <br /> ty{ae g duposed If this waste is later fo exceed 1yuaatky Ftmilo.or <br /> o tflatcnale ncf epeapted tptdt thfa pmfprttm I ttgrots to coMlete a hazardous waste manihitead y ti ith state tegulations i <br /> at;appmptiate. ,€ <br /> 7 fAfifRt Sl <br /> .. .�. QsrtX86: ' t <br /> -XPA,n itt L G U <br /> is <br /> COMANY:PHONE: } s�f32' r 2 TITLE: <br /> U COPMETRO BY PHIMtFTA*HMitTATIUUT;&REM&71YA[� -1I�f AfiP�. <br /> MOB <br /> P <br /> 'lug <br /> l5 �a <br /> 1 . <br /> raj <br /> &TJW1Ar: E 'IY Y C&W COB% a #IHCR;m 01 AIDS ` <br /> j .`ClG7A118:�w 'C tt ASS3 fi21CS akt ._ A <br /> `rtrGM xevWtt <br /> w <br /> 4N RECFSPT <br /> r <br />