Laserfiche WebLink
Date of Event. T <br /> 11855 WHITE ROCK ROAD Time' �a <br /> RANCHO CORDOVA,CA 95742 Informed: <br /> (916)351-0980 Times Participated: <br /> ENVIRONMENTAL SERVICES <br /> GROUP — <br /> W.t�-R TITY GENERATOR WASTE <br /> CONDITIONALLY EXEMPTS LL QU <br /> CHECK-IN RECEIPT AND CERT1171CATION STATEMENT <br /> TO BE COMPLETED BGENERATOR: <br /> [further certify that I <br /> I certify that the following information is correct,Sm ha°uanh�aGenerator Waste Accepderstand the rtaacc ProCnIents gram-participation in the Philip <br /> Fede land California State regulations,and this quantity of waste <br /> Transportation and Reroedianon Inc.Conditionally Generatorasdefin ll Q <br /> am a Conditionally Exempt Small Quantity e of waste beingdisposed. If this waste is later found to exceed small quantity limits or <br /> does not exceed the specified limits for the type <br /> contain materials not accepted under this program.1 agree to complete a rdous waste manifest and comply with other state regulations <br /> as appropriate. <br /> SY ^ � OMPANY REP/: <br /> COMPANY NAME: D e PAZ <br /> COMPANYADDRESS: ^� SIGNATURE' (Z,- <br /> c _ ---- <br /> CITY,STATE,ZIP: TLE: ^ -'`}�e`- --« DATE: <br /> COMPANY PHONE: OS- <br /> E COMPLETED BY PHILIP TRANSPORTATION & REMEDIATION CRECK-IN ATTENDANT <br /> To B TATE S/ a OF CONTAINER WASTE WT(LB) METH COST <br /> GENERAL WASTE DESCRIPTION HAZARD CLLSSS WASTE ODE L i OM TIiPFJSEM20LtNT <br /> CHEMICAL CONSTmENT Ph. ETG �� 1640-( <br /> 1 <br /> DD r CA e,( <br /> LcWx n <br /> ef <br /> 30 A- <br /> 61I �� IZ 10-1 °� ]x'7�j0 <br /> u Seg 40 , I o� 11010 <br /> Z °� <br /> roti r <br /> ONt+f� <br /> JJ TOTAL PAID$ <br /> CASH C3 CHECK CHECK O. L <br /> METHOD OF PAYMENT: DATE <br /> PHILIP TRANS&REMED CHECK-IN ATTENDANTS[NI LS CHECK-IN RECEIPT <br /> mc-107 ayvoVII <br />