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11835 WHIT CK ROAD <br />RANCHO CORDOVA, CA 9 <br />Et1to <br />90(916)351-0980 <br />�1L SERVICES <br />—�- - CROUP T� <br />vkswn t'e;m <br />/U olno-Ne*4 <br />Date of Event: <br />1$ 1.*/ 1z) -/ Time: , 17i <br />Informed; <br />,Tortes Participated: <br />I eion a that the following Inc.Cor inion n is correct, and I have read and understand the requirements for participation in cite Philip <br />Transportation and Remediation In. Goriditionally Exempt Small, Quantity Generator Waste Acceptance Program. I fartber certify that t <br />am a Conditionally Exempt Small Quantity Cknerator as defned'by Federal <br />does not exceed the specifiedand California <br />State regulations, and this' tlitantity of waste <br />limits for the type of waste being disposed, and <br />this waste later found exceed entail quantitylimits or <br />contain materials not accepted under this proiram, I agree to complete a hazardous <br />as appropriate. waste manifest and comply with other slate regulations <br />COMPANY, <br />COMPANY DD. <br />CITY, STATE, ZIP: <br />i <br />Lyi <br />CHECK NO. <br />11LIP TRANS & REMED CHECK-IN ATTENDANTS INITIALS <br />REV 08&11 <br />SIGNATURE: <br />CHECK-IN RECEIPT <br />