Laserfiche WebLink
v � ; -4 <br /> 0 0 o <br /> O rQ m <br /> G) o <br /> v o � <br /> o <br /> � Data pP$vanv October 20.2016 � (n <br /> 14.0• !1355 N'ii r ._.i3=� -E7!__.. "-' <br /> Ill �0 5t e' 119 95742 1mc <br /> RAt•14HD inPeerned: <br /> _ • 1416) <br /> '1'imav Participated: _-..- �• ,--� <br /> D <br /> 1 < <br /> CONDITIONALLY EXEMPT SMALL,QUANTITY GENERATOR WASTEP O <br /> CHECK-IN RECEIPT AND CERTIFICATION STATEMENT � <br /> p'Al Fid t O411'I_.ETFT,D RS'GFNERATOR: <br /> certify that the following Information Is correct,anJ i have read and undcrstand the requirements for participation in the 0. <br /> 7 <br /> Stericycle CunditiotWly Exempt Small Quantity[generator Wrote Acceptance ProP,rdtn. 3 furtlrur certify that t am a Candltlonally 8xempt 1+ <br /> Small quantity Generator>s defined by FedwW and California State regulations,and this quantity of waste does not exceed the specified <br /> limits for the type of waste being disposed. If this waste is later found to exceed smnlr quantity limits or coats. matriatz. not accepted t <br /> under this program,t agree to complete a hazardous waste manifest and comply with other state regulations as appropria[c. � <br /> N <br /> COMRANY NAME: Vintage Pool Service&More COMPANY REP-- Athena LaRue <br /> O <br /> COMP.aNz'ADnu>;ss: -)780 E. Yosemite Avenue EPA IDN: CAL C1 14833 <br /> SIGNATURFr.t <br /> crrr,sI_�rF,zip: Manteca, CA 95336 (�`�� <br /> COMPANYPHONE.- (203) ,599 830 TITLE: h ` PATE: <br /> TORE COMPLETED BY STERICYCLE CHECK-IN A7'TCt NDANT <br /> "+.. �.ir V --']'�, R'-iiia: 1-LALAH.D AFI �T.aTP S! iiC1F CUN�7�1N WASTE *'11LB) I]SSP. COST O <br /> tl.. ',h. .a .atis ivgtiil .,�9k L- CONI '['YI?FJ5i7_F .AMt�]TIT Mf'.TI! <br /> Chorine 8 �4 5gal 21s.3' <br /> �.:f prine-Tablets $ 1 5gal 441 57,24 <br /> CD <br /> .-r <br /> 1 � <br /> } N <br /> I � <br /> I O <br /> 1 I � <br /> Fee <br /> PAYMENT: Cr1SfI D CHECK O CHEC;KNU.)-3J5 TOTALPAID$ 2`);=r.•`',' <br /> m <br /> CIfE(K-P.AfTLvli/trirS It il1,�f DATE jD`c- OL-) a o cQ o <br /> t v a <br /> s � <br /> O <br /> 01 <br /> N C) <br /> CQ O <br /> CD v <br /> O) Oo <br /> 0 <br />