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53S GETTY COUKr, SLUE H Date of Event: <br />NEV BENICIA, CA 94510 Time: <br />(877) 749-3W lwbmaed: <br />t5R4 Times <br />6 <br />GROUP - <br />We P'tgkon <br />4— 11 q_ <br />7W <br />CONDIT]0—N_ LY EXEMPT SMALL QUAINTITY GENERATOR 'WASTE <br />CHECK-IN RECEIPT A34 -D CERTIF ICATION STATE -W NT <br />TO BE C 0IMPLETED BY, GENERATOR: <br />I certify that the following- I <br />information is correct, and [have read and understand the reqt&ements for parficipaiiao ij--- the -Philip <br />Transportation and Rezaediaion Ina. Conditionally Exempt Small Quantity Generator Waste -Accoptanoe F-rograin- 1 farther caoitfy� that I <br />am a Conditionally Exempt Small Quantity Generator as deEmed by rederal and CalifornL; State regulations, and this quantily of waste <br />does not exceed the specified limits for the type of waste being disposed. If this waste is later found to exceed small quantity Urnits Or <br />contain materials not accepted under this prograiu, I angree to con, y <br />complete a haza-rdous waste man-ifest and comp -1 with adi-tr state reguliationg <br />as appropriFte- <br />COAVANY NAME- lip— <br />COMPANY -A_J1DRFSS:' 71/0 Lfz;r"j'vAC_ <br />CITT, STATE, ZIP. f,p <br />Co.Mp._J_Nty F14 <br />CO Nof PAN -Y REP: <br />EPA LD_': <br />SIGNATURE: <br />TITLE: � ivui V, RAT& <br />0 BE C011APLETED BY PHIL21 TFLALMSFORTATION & REMEDUTION C—TIECK-l"W ATTE-INDANT <br />GENIER-A-1 NVASTE DESCRIPTION <br />HEMTCAL CONSTMUENT, -Pb.. ETC. <br />FIAZARD, <br />CLASS <br />Ajq <br />WASZM <br />STAIVE <br />CODE <br />L <br />CONT <br />TYMSTTE <br />WASTS 7,1TrL8) <br />-AMOLNIT <br />DISR <br />ZYCE-Mi <br />COST <br />p <br />49 1 ETHOD OF PAYMENT- CASH 0 CHECK El CHECKNO- <br />-2, <br />0141LIP TRANS & REMED CHICK -IN ATTENDANTS R%Ur-.ALS dga= <br />LI/ <br />TOTAL PALD $ <br />DATI S <br />Esc -207 REV 12J06 CHECK -LN RECETT <br />