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11855 White Rock Rd. <br /> '%Atency Rancho Cordova, CA 95742 12/1112019 <br /> de Date: <br /> (916) 351-0980 <br /> Time: 8:00 AM <br /> CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR WASTE CHECK-IN AND CERTIFICATION <br /> RECEIPT AND CERTIFICATION STATEMENT <br /> LTo be completed by the generator:_ i <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: CRM Co., LLC Company Rep: Stephen Krauss <br /> Company Address: 1404 S. Fresno Avenue EPA ID# CAL 000 450 997 <br /> Stockton, CA 95206 —Sign at.0 re: <br /> Phone Number: 209-662-6090 Title: -0d VA Date: 12,—/o <br /> -, 7 <br /> TO BE COMPLETED BY STERICYCLE CHECK-IN ATTENDANT <br /> General Waste Description(Chemical Haz. AH State Sit #of Container total Waste Total Waste Disp <br /> Constituent,Ph,WTC.) Class Waste Code Cont. Type/Size (gal/ft) (pounds) Meth Cost <br /> 4' Fluorescent Bulbs UW S 837 Barreled 3348' $502.20 <br /> Dawn Dishwashing Liquid 6.1 L 24 oz .375 gal $3.05 <br /> lControx Effervescent Deter. 6.1 S 1 500 g 1.1 lbs $1.54 <br /> ICEM Fat Extract 6.1 L 1 8 oz .06 gal $0.50 <br /> :Antibacterial Hand Soap 6.1 L I I gal 1 gal $8.25 <br /> !CaviCide Disinfectant Clean 3 L 2' 1 gal 2 gal $7.00 <br /> Cupric Sulfate Solution 6.1 L I I L .26 gal $2.15 <br /> Baking Soda 6.1 S 2 4 lbs 8 lbs $11.20 <br /> Ethyl Alcohol Denatured 3 L I I gal I gal $3.50 <br /> AJAX Bleach 813 S 1 28 oz .88 lbs $1.23 <br /> Comet Disinfectant 6.1/813 S 1 17 oz .5 lbs $0.70 <br /> CRC True Tap HD Cutting 6.1 L 1 16 oz .13 gal $1.07 <br /> Hydraulic Oil NR L 4 5 gal 20 gal $70.00 <br /> Processing Fee $20.00 <br /> Method of Pymnt: Cash Check# Inv Total Paid' $632.39 <br /> Stericycle Check-In Attendants Initials., Date: <br /> 0;CdrF Ceand -ke <br />