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2 <br /> ._.loot t$Vell L' �J V <br /> 14 <br /> 11855 WWrE ROCK.ROAT) Time: ei <br /> RANCi10 CORDOVA,CA 95742 Informal: ---------=— <br /> (916)351-0980 Tines 1'at1ic1p31cd' <br /> yylgp.. Gnout.56IWr� <br /> .�� GRttln' <br /> Wesm a lkle m' <br /> CONDITIONALLY EXERTFT SNTAI'('QUANTITY GENERATOR-WASTE <br /> C1iECK-1N KI:CI'',1PT AND CERTIFICATION S'I'ATF.MENT <br /> 1'0 BCOMPLETED BY GENEitAI'OR: <br /> T <br /> Generator Wavtc Acceptance Program. 1 firther ccrti fy Must I <br /> 1 certify that the fulWwi¢g i¢fmwntion is correct,and T have reed and undetetnrsd the requixetnents for panieipalion in the Philip <br /> FcdL al and California Suite reb`ulatismx, and Ibis quantity of wstitc <br /> 11 arsponntion Mid Remediation Inc. Conditinnally LF'empt Smldl Quantity <br /> am a Conditionally L)unpt Small Quantity Generator as defined by <br /> does not exceed the specified limits fur rhe type of waste being disposed. if this waste is manifest <br /> found o exceed small quanr stately limits or <br /> contain materials nut accepred under this program,i agree fi wmpl tc x hazardous waste manifest a(n�d�comply with other state regulations <br /> as appropriate. <br /> .tQ I`Z�PA L 2 COMPANY REP: rJ t <br /> (!()MI'ANVNAMF: EPA IDN: L000 2 <br /> C.OMYANYADDRESS: . I.3(q (COvt Sf _ <br /> L CA q520 SIGNATURE: Y" <br /> CITY,STATE,ZIP: �Kf ���Z TfrLE: (, G( IJ DATE: ' <br /> COMPANY PLIONE: <br /> TO BE COMPLETED BY PHILIP TRANSPORTATINT <br /> ON & #REMEDIAl>ON WSiTE W 1,R)TE)NP. COST <br /> 11ALAkl) All STATE q MINH <br /> OL'NL•RALWASTR nRBf:RIP'I'IUN WASTE cortE I (%)N'I' IYYI%SIZE AtvIO al .jdn` 2- <br /> D��cAL c.(.) 9•I�Ttll urc. cl-A 3- .S� 30 tY <br /> min 7l Ilk" <br /> 1 Com• .L gjUy <br /> IEC 9 2017 <br /> =NV1 ONM N L HE L <br /> rQ TOTALYAID$ <br /> ME'1110D Or PAVMFNTo CASH O CHLCK CIIL'CK NO. �Y � <br /> DATE O I ) <br /> PILILIY IVANS&RF.MT:D CHECK-IN ATTENDANTS 1NII1AL5 CTTFCK-RV RECEIPT <br /> vac-sin nnv osru <br />