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0412612011 06: 28 2094662P—' STOCKTON AUTO PAGE 01102 <br /> 535 GETTY COURT,SUITE H Dstc of Event: <br /> BENICT&CA 94510 , <br /> Time: <br /> (377174$-3040 <br /> Informed: <br /> KSV ItONtrtfrr+rl S?SLLtriCE9 Timen PaGROUP <br /> rticipated: <br /> lrmrcrn Rt&n <br /> COiNDITIONALLY EXEMPT SMALL QUANTITY'GENERATOR WASTE <br /> CHECK-IN RECEIPT AND CERTIFICATION STATEMENT <br /> TO BE COMPLETED BY GENERATOR: <br /> I certify that the following information is correct,and i have read and understand the reguirerneuts.forpartilcip4'tion in the Philip <br /> Transportation and Remediation Inc. Conditionally Exempt Sruall Quantity Generator Waste Acceptance Program. l fil'IthET certify that 1 <br /> am a Conditionally Exempt Small Quantity Generator as defined by Federal and California State regulations,and this quantity of waste <br /> does not exceed the spe,ified limits for the type of waste being disposed. If this waste is later found to exceed smhll quantity limits or <br /> contain materials not accepted under this program, l agree to complete a hazardous waste manifest and comply with other state regulations <br /> RS appropriate. <br /> /_C / <br /> COMPAI�fY NAME: C.�d'l�� � i`l `'�G�`%^ CONITANY REP: <br /> COMPANY ADDRESS: vi�3� �I1 .� � �' r-.rA iw: <br /> Cr",STATE,ZIP, �i�r(q_.1 -,� L\ c% t" 6 ._ <br /> 1 �7 � 5Il;Nr#7'URIE;: <br /> COMPANY PRONE: TITLE: DATE: <br /> TO.BE COMPLETED BY PHILIP TRANSPORTATION& REMEDIATION CHECK-IN ATTENDANT <br /> GENERAL WASTE DESC lUPTION HAZARD A.H STATE S/ #OF CONTAINER WASTE 1 WT(TX DISP_ COST <br /> CHEMICAL CONSTITUENT,ph ETC. CLASS WASTE CODE L CONT TYpr/SMZE AMOUNT MP.TH <br /> CLt.J-c Lu <br /> METHOD OF PAYMENT: CASH 0 CHECK Q CHECK NTOTAL PAS$ <br /> Z, <br /> PHTLfP TRANS&REMEl3 CHECK-IN ATTENDANTS INITIALS DATE <br /> MC,zm xr'v IV06 CAFCK-IN RECEIPT <br />