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7yQ i• 11855 White Rock Rd. <br /> Stericycle <br /> Rancho Cordova, CA 95742 Date: 1/8/2020 <br /> (916) 351-0980 <br /> Time: 8:45 AM <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 following 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.If 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: Onions ETC. Company Rep: Tony Murguia <br /> Company Address: 1003-C Humphreys Drive EPA ID # CAL 000 451 633 <br /> Stockton, CA 95203 Signature: <br /> Phone Number: 209-327-8399 Title: Date: <br /> TO BE COMPLETED BY STERICYCLE CHECK-IN ATTENDANT <br /> General Waste Description(Chemical Haz. AH State S/E #of Container Total Waste Total Waste Disp Cost <br /> Constituent, Ph,WTC.) Class Waste Code Cont. Type/Size (gal/ft) (pounds) Meth <br /> 4' Fluorescent Bulbs UW S 174 Boxed 696' $104.40 <br /> 8' Fluorescent Bulbs UW S 17 Boxed 136' $20.40 <br /> Metal Halide Bulbs UW S 34 Boxed 2S lbs $75.00 <br /> Non-PCB Ballasts NR S 15 Each 38 lbs $30.40 <br /> Hydraulic Oil NR L S 5 gal 25 gal $87.50 <br /> Processing Fee $20.00 <br /> Method of Pymnt: Cash Check# Inv Total Paid: $337.70 <br /> Stericycle Check-In Attendants Initials: Date: <br />