Laserfiche WebLink
11855 White Rock Rd. <br /> %6R Stericycle Rancho Cordova,CA 9 742 Date: 2-/5/2020 <br /> (916)351-0980 <br /> Time: 8:35 ANS <br /> CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR WASTE CHECK-IN AND CERTIFICATION <br /> RECEIPT AND CERTIFICATION STATEMENT <br /> To be completed by the generator: <br /> I certify that the fallowing information is correct,and I have read and understand the requirements for participation in the Stericycle Conditionally Exempt <br /> Small Quantity Generator Waste Acceptance Program.I further certify that I am a Conditionally Exempt Small quantity Generator as defined by Federal and <br /> California State Regulations,and this quantity of waste does not exceed the specified limits for the type of waste being disposed.lf this waste is later found <br /> to exceed small quantity limits or contain materials not accepted under this program I agree to complete a hazardous waste manifest and comply with <br /> other state regulations as appropriate- <br /> Company Name: Nasco Electric Sign Company, Inc. Company Rep: Pam Lindsey <br /> Company Address: 3180 N. Ad Art Road EPA ID# C 000 290 917 <br /> Stockton, CA 95215 5ignatur : ` <br /> Phone Number: 209-931-1924 Title: Date' <br /> TO BE COMPLETED BY STERICYCLE CHECK-IN ATTENDAN <br /> General Waste Description(Chemical Haz. AH State #of Container Total Waste Total Waste €3isp Cost <br /> Constituent,Ph,1NTC.) Class waste Code S/t Cont. Type/Size {gal/ft} (pounds) Meth <br /> Contaminated Motor Oil NR L q 5 gal 16 gall ,Qg <br /> Processing Fee $20.00 <br /> Method of Pymnt: Cash Check# iV Inv Total Paid: .DD <br /> Stericycle Check-In Attendants Initials: � Date: <br />