Laserfiche WebLink
Jan. 09.2013 17 :04 P- ele431ECBEAVED <br /> 50 PAGE. 1/ 1 <br /> ®001/041 <br /> 11453 WHITE RM ROAD JAN 0 9 2013 <br /> RANC,'lffp CORWYA,CA 95742 [xue of Eyemt: <br /> (916)31149#o SAN JOAQUIN COUNTY Times <br /> trrnrttorrre�rrel.�aavtcYr ENVIRONMENTAL lWaonnsd; <br /> " GROUP HEALTH DEPARTMENT 7"ueai p■trd: <br /> CONDITIONALLY EXEMPT,SMALL QUANTITY GENERATOR WASTE <br /> CHECK-IN RECEIPT AND CERTIFICATION STATEMENT <br /> TO BE COMPLETED BY GENERA'T`OR: <br /> S certify that the following tnfbrmation is cbrrect,and I have read and understand She requbwnents for participation in rhes Philip <br /> TYInsportation and Rims iation Inc.Conditionslly,Exvmpt Smali Qtmllty Generator Waste Acceptance ProgrwL I fitrtha mortify that I <br /> am a Conditionally Exempt Smell Quantity G=erator as def9nod by Federal and California,State regulations,and this quantity of waxte <br /> dote not exceed tho specified limits for the typo of wsate being dieposed, If this waste is Iota found to exoeed aniall quantity limits or <br /> crmtain materials not acoepted under this prop=,l aXM 6 complete a hu"dcas waste manifoat and comply with ather stat*reguhniotrs <br /> as spprepriete. <br /> COMPANYNAMZ: LW, COMPANY REPt <br /> COMPANYADlDUM: 1 i! 11-jXPAam; III Is <br /> _. . ..,. <br /> CITY,STATZ,Z,IPt * BIGNATURIK: <br /> 4�w w <br /> COMPANYPHONE: (20�) �.'' I'T7'RE; cr' %/'i E'r� DATE' / / <br /> _1A MOT 1 11 <br /> TO HE CONPI.$TED BY PHILIP TRANSPORTATION&REIv EDIATTON CHECK-IN ATTENDANT <br /> CRqMOMAL <br /> LCA WNI'm) 7rON HAZAAAD AN STATIC $I Y OF r:Ot�"X"am WASTE WT(L e) QI <br /> � <br /> oil- AL , <br /> 8 <br /> METHOD OF PAYMENT. CASK © CRACK 0 CIIHCK NO. ._, TOTAL PAID <br /> PHILIP TRANS A REMED CHECK-IN ATT ENOANTSi INIM S � DATE <br /> pscaor acvs�r S$ (� tUCK-INRECRIPT <br /> :, Credit Card Ending In <br />