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Mar . 13 . 2020 11 : 28 AM Parkwoods Cleaners 2094774397 PAGE . 4 / 8 <br /> I1855 Wk11TE 1;c7ci� ItOATa batao[' Evoar t1�1 .. ' . 1 1 �( � <br /> w0 Ste ricycle' Rarfri o cIwoVA, 95742 informed* <br /> 09i0 (91 G) 351 .0980 - ^—" <br /> 1Y:z:as t'nrtiulpatcd; ,�_„��,__. w� <br /> CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR WASTE <br /> CFfVCIK-IN RECRIPT AND CERTIFICATION STATEMENT <br /> 11 1 11111 <br /> TO BE C(9Mt'�,E'I,ED BY +GEN1;"TORa <br /> I Cori*, that the following Information Is correct, and I havo road and understand the requirctnentg for fiarticipatlan in the <br /> Stericycle Conditionally Exempt Small izuantlty (kaerator Waste Acceptance. Proms. Y fi,rtiier eorttry that I am it Candtttonally Exempt <br /> Small Quantity Conerator as defined by WOW and California State regulatiaua, and this quaotiry of waste docs not excc+sd the apcciCted <br /> litYtits for tho Vpa of waste boisng disposed, If thwasto is later ,found to exceed smI quantity limits or cotataW matorials not accepted <br /> under this program, I agroo to complete a lutizardous wRste manifest and comply with other state regulations as appropriate. <br /> COMPANY NAM)E : jr�r ,"� �� 1C. ��.��? ,tl�' �';�� COMP,�PrxREN <br /> COM PA.NV ADbItESS: ,tel , au. l r ,� � . >n1lyA TDO: "� _. <br /> C;II"1'. 87'A'I'g, 7,XI' : i '. ` Y"s ' 1IChfArOXiE: <br /> COMPANY P110Nly: TMEt: �.x nArr: <br /> TO BE COM) LETED BY S`I TRICYCLE RECI(4IN AITENDAN' <br /> C33GN01CAC, W 'PF p115C1tYft!10N WARD At1 STA91G S'Ct VJ1'(f,i3) . riiSly. GEST <br /> r CLASS 1V 8 i G C0T)fJA yl 019M <br /> ._. <br /> P1i . >:PC, Lt�.�.:_ .__.. ,�.: .., <br /> ---- t�lrf ., � LJ� 11,. •.�, <br /> Zpig` <br /> . ,� <br /> �M)P r4,: �.» �. t '1t'~v fe::J4� <br /> 1 <br /> IW— <br /> nktbt <br /> �.... <br /> IV <br /> NET1100 ov I' X1A T: CASH © CHECK Cl CHECK NO,. � TOTAL PAIli $ . . <br /> ti <br /> S"11;1tICYCiJI Cty QIP Ctal�tl•�i1n.Ta� . .s .41 _ tAmE � .� " <br /> f.R1 DrC >? E$15ING tri 1 41 <br /> trEi1�C SIN 1i8CEi['"f <br /> . .. ,.-. y .,, .'I <br /> MAf?.._ _ 2�2J - . . -- _ . <br />