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N1ar . 13 . 2020 11 : 30 AM Parkwoods Cleaners 2094774397 PAGE . 7 / 8 <br /> t <br /> II855 Wlq. 0go t(01",r, ROA 1 ) OnttlOf hNeent! A . uo + rf r) r. that; • <br /> i** 5t@ItCYCltl' ltn*1lgrnretter"$ ohne ns^r � ) ;lme; �ua taiL?_— <br /> " <br /> 1916)'3Z0980 Informed: <br /> "rimae FRrilCipatod! <br /> CONDITIONALLY BUMPT SMALL QUANIn T+Y GENERATOR WASTE <br /> CRECI"IIT RECEIPT ANTI' CERTWICA'TION STATEMENT <br /> TO BE COWLETED BY GENEBAT094 <br /> I certify that the Ulowing Inibrmation Is oonvo4 and 1 have read and understand the requiremauft for peatltiipattoo in the <br /> Storicycle Conditionally Exempt Small Qpanuty Generator WasteAcceptance Program. 1 fltrther certify that I am R Conditionally Exempt <br /> Small (quantity Generator as defined by Federal and California Stoto ngulAtions, and this quantity of waste does not exceed the specified <br /> limits tot the type of waste being disposed. It this waste is later found to exceed small quantity limits or contain materials not accepted <br /> under this program, Y We to complots a hazardous waste manifbst sail oanaply With other state regulatlane as appropriate. <br /> COMPANY NAME: Parkwoods Clegaers . , . . COMPANY REP: T Jeff Kittq. .. <br /> - — <br /> COMPANYADD RES$; 1762 W. Hammer Lane ZPAlft Ai Ae1nek3Av4X: 0ek 1`6 <br /> Cl7'X} STATE} ZIP, StocKtoCt „CA 95209 SIGNATUIIEt � <br /> COMPANYPAONEt ( 209 ) 4774397 T]< 1tLE� riATl�t <br /> TO BE COMWLETED BY STERICYCLE CHECK-IN ATTENDANT <br /> di Nt1ttAL WASTE DESCRIPTION HAZARD AH STATE V 900 CONTAtMBR WASTE WT(Gs) Dispe COST <br /> t:tltiMtCALL CONST1TtJ[itJTPh*, BTCe) :LASS WAG7 } 1Yi? 3 tdl � tvlm <br /> 011 , Grease w/ OI col 34ea�l 5B- <br /> __. <br /> Ether <br /> Processing Fee , . - _ - - 20w <br /> METHOD OFPAYMENTt CASH 0CTIECK 0 CHECK NO, � �} _ TOTAL PAID $. <br /> 4l'SRICYCLECHECKaINATrrENDAN*i1.,9 INITIALS . ., . �l.L ... DATE <br /> vsMaot ALV was CHECK IN RECI31PT <br />