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� G1955 White Rock Rde <br /> R,71nicho Cordova, CA 95742 Crete . 2/26/ 2020 <br /> ( 016) 351 =0980 <br /> Tune : 8 *445 AM <br /> CN61 f <br /> ± ' E 'V � RATOR WASTE CHECK4N AND CERTIFICATION <br /> tRFCL V k LLAtTI ICATI N STATEMENT <br /> To be completed by the generator : <br /> ce .tiiy aiE �t trE . Eoiioe e t � o . E . � aL, can is cut cr� ci, Lind i have reap and understand the requirements for participation in the Stericycle Conditionally Exempt <br /> Small Quantity Generator GAfaste .` Icceptance ' ogr , rn . I fUt '.cyr c .M v that 8 ain a Conditionally Exempt Small Quantity Generator as defined by Federal and <br /> California S€ d '� z guiG � � EES, a � E � cluar , rity c f waste does not exceed the specified limits for the type of waste being disposed . If this waste is later found <br /> to exceed srr . ail quariv s units or contain rnateria :s riot accepter, Loder ':his program I agree to complete a hazardous waste manifest and comply with <br /> other state regulations as appropriate . <br /> Company ti uLi "ld ' s Ace Hardware Company Rep : Rindy Crawford <br /> comp � r./ kkcl " c? �jo hm w1v gR EPA ID # CAL 000 402 175 <br /> Signature . <br /> 4.i JJ �. JB . <br /> Phorie I . . , . ., _ . - i W � 2 Title : ,� , � . ,, •� ;' Date : � _ ZZ � �F <br /> APLL re � � BOY STERICYCLE CHECMN ATTENDANT <br /> - _ - <br /> I - )iy o�Cntainer Total WasteTotal Dis <br /> pGerte � � ft <br /> h Cost <br /> Ph ` ? i CJ s € ,Pasta I L' Cj i Cony . Type/Size (gd / ft) ( pounds ) P�leth <br /> all,Colain s� tr. . . � . . ii� _ ., _ . . � I � . � � l � 4 1 1 � t 25 lbs $ 00 � 5 <br /> Key ( aLIW <br /> Varied b X1 . 40 1 . 15 <br /> - I 7 . �! <br /> Aero b <br /> Pairs _ - E I i Varied 2 . ' S gal � .- $ <br /> - <br /> 0 <br /> CV ' S " t� v` i i Eatr� � <br /> - <br /> AI �cI <br /> 4lbs <br /> til i 1 szt i _ > g . . <br /> Po � e ( , i sags 515 lbs , 10 <br /> Suregrivp <br /> Pa c� . j i � ; 1 6� t 15-gal --- � r§ <br /> — 1- , 23 gas <br /> r <br /> j2 <br /> -; 11 gal T: <br /> + t <br /> I gal <br /> iii _ , t <br /> I (jai <br /> � l <br /> C3 . �. E <br /> " gal `1 gal <br /> i ! <br /> I — <br /> k <br /> tf f C <br /> E <br /> - . s Total Paid : <br /> _ x <br /> ' • � , �{ it Date : <br /> 4Or.7__ .�,f <br />