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Ub/U4e2U15 THU 13:51 FAX <br />ca11955 WHI'11' ItOCK ROAD <br />RANCT40 CORDOVA, CA 95742 <br />(916)351-0980 <br />nNvTRoNMarrrALt;envtut s <br />Gnoul, <br />Wu e,n Rc&n <br />E002/002 <br />Data of Evcnt: June 5 2015 <br />Tune: " <br />lnfunucd' --• <br />limes Yrnit:ipntccl� <br />CONDITIONALLY 11MENTT SMALL QUANTITY GEN MATOR WASTL <br />C11 .CK -IN RECEIPT AND CERTIFICATION STATEME, NT <br />TO BE COMPLETED EtY GFNERA'1'O H: <br />1 certify that the following information is correct, and I have road and understand the requi;i t merits fur partieipatiou in the Philip <br />TI aasportation and Remediation Inc. Coadiliounlly Exempt Small Quantity Generator Waste Accepintzee Program. I fiuthcr certify that I <br />ern a Conditionally Exempt Su2611 Qutwtity Genetator a9 derined by Federal and Califontda State regulations, and thin quAntity of Waste <br />does not exceed the specified limits for the type of waste being disposed. If thin waste is later fowid to exceed small qu atity limits or <br />contain materials•not•accapia uMer-this program, 1.agree to complete a 11MAJous waste manifest aad comply. with adui stato.regulatium _ <br />as appropriate. <br />COMPANY NAM; B+B Ti es & Auto. Service COMPANVICXP: Rgnee <br />COMPANYADDRE-58: . 39 EPA ma: CAL 0366540 <br />r SIGNATURE. <br />COMPANY PHONE; ( 69) 339-19162 TITLE: /1v C4 pAT)V: <br />• 2 1 1 •'1 •' •• 1 1 :1 1 1 <br />� <br />. 1 vl .t_ •i•1 ►' .1MLi-ia ' ill. til«G't•�1 <br />172M.tttm!1•J!81 <br />N <br />% <br />• r <br />� <br />ul� <br />Brake • It:XI��_®�� <br />1 <br />• <br />1,Processinci Fee <br />AMEN <br />�0 <br />FEE® <br />0 <br />FEE <br />® <br />INE <br />_MINE <br />■MINE <br />-51 <br />INNINNEINE <br />ANNE <br />M KT) (00 OF PAV Ml3NT. SH D CI LOCK /� CHECK NO. , f -, <br />P111I•IPTRANS&REMEDCHEC-INATTENDAN"INITIALS <br />PSC -207 "V all I <br />TOTA , wo s 176.00 <br />CHl'•CK-IN RL'CEIPT <br />