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I lass Wl ROCK ROAD Data of Bvmt, ' <br /> RANCHO RI?t7VA,CA 45742 79mc <br /> SN"UNMITALUri=03(916)3514990 1nPotsltu0: <br /> —��GROW 71roep Participated; <br /> V.N.aye <br /> CONDITION Y RXEMiP'R'SMALL QUANTnY GENERATOR WASTE <br /> CAEC -IN RECEIPT AND CERTIFICATION STATEMENT <br /> TO SE COMPLETED BY GENERATOR: <br /> 1 outify dig tho following In stien is correct.and 1 have road and understand the requiramvnts for participation in the Pbilip <br /> Tfansportation and Urnedittion Inc.C nditioftaily Exempt Small Quantity Generator Waste Acceptance Prom. i fWthe3r certify that i <br /> an a Conditionally Exwvt SM11 Qu toy G m ator as defted'by Pedeml Aad California State regulations,and this gwmdty of waste <br /> does not exceed the specified limitsf the type of waste being disposed. if this waste it later found to exceed small quantity limits or <br /> contaln materiels not accepted under th s propm,I agree to complete a hazardous wrote manifest and comply with other state regulations <br /> as apprppriau. <br /> S <br /> COMPANY NAA+L r 0r•k1..1-AK COMPANY BSP: <br /> COMPANY ADDRESS., 11AL RPA Eft OO � <br /> CITY,STATE,ZIP; CA Itc.,2bfa R.GNATURZ: <br /> COMPANY PHONE., QN ' 0 - 2_ 7nm: <br /> 7S — <br /> TO BE COMPLETED EYP LIP TRANSPORTATION&RRMF.DIATION CHECK4N ATTENDANT <br /> t78 GRAL WAM 130CIlP1WN K42ARD I AH STATS 8/ 0 41P C(NTADM WAM w r") D16P. 008T <br /> $1.11 WA9 + NT p <br /> f <br /> METHOD OF PAYM$NT: CASH Q CHECK G CHECK NO V:22 TOTAL t t Q <br /> r <br /> px11,1r TRANS&RE,sga cH>rc>K•IN aTTENDANTs 1Nl'I'1ALS <br /> DATE <br /> PSG707 99vW11 CHECK-IN RECEIPT <br /> Page 212 <br /> £/Zd S£tr£89bfi0Z <<LSVZ59tr60Z 038vvil]0 6ZU t1Z-80-Z60Z <br />