Laserfiche WebLink
EM 0 OCK ROAD kof Event: 0, A <br /> R- / <br /> 11855 WHITE Time: elpgaiv" <br /> RANCHO CORDOVA,CA 95742 Informed: <br /> ENVfELONMENTAL SERVICES(9-16)351-0980 Times Participated: <br /> GROUP <br /> westem R&&a <br /> CONDITIONALLY EXEMPT SMALL QUANTITY GENE RATOR WASTE <br /> CHECK-IN RECEIPT AND CERTIFICATION STATEMENT <br /> TO BE COMPLETED BY GENERATOR'- <br /> a <br /> I certify that the following information is correct,and I have red and understand the requirements for participation in the Philip <br /> Generator Waste Acceptance Program. I further certify that I <br /> Transportation and Remediation Inc.Conditionally Exempt Small Quantity <br /> am a Conditionally Exempt Small Quantity Generator as defined by Federal and California State regulations,and this quantity of waste <br /> does not exceed the specified limits for the type of waste being disposed. If this waste is later found to exceed small quantity limits or <br /> contain materials not accepted under this program,I agree to complete a hazardous waste manifest and comply with Other state regulations <br /> as appropriate. <br /> R <br /> COMPANY NhkOMPANY REP:P: <br /> AME: —�&11 <br /> L�-e'Lill <br /> CITY,STATE,ZIP: Zla(A4 EPA 1D#: <br /> COMPANYADDRESS: <br /> 0— SIGNATURE: <br /> �dl 6 Om/ <br /> ,L, - // - DATE: <br /> 0 TITLE: <br /> CO PRONE: <br /> ON&REMED114TION CHECK-IN ATTENDANT <br /> TOBECO E BY PHILIP TRANSPORTATI <br /> - #OF CONTAINER WASTE WT(LH) DISR COST <br /> GENERAL WASTE DESCRIPTION HAZARD Tui——STATE S1 AMOUNT <br /> (glIn�CAL CONSTITIJENI Ph..ETC CLASS WASTE CODE L CONT TYPEISIZE, <br /> I — -- <br /> ga ink <br /> Ne <br /> 40 Lj1j';&r <br /> F! able Aqotd <br /> 11 AJ/Z <br /> a4t�L at'if <br /> 671446 <br /> v <br /> LETED <br /> 4(_4 <br /> F ble qb(td <br /> ar 14f <br /> b-il <br /> Fl�wmli�ehw�e <br /> kL VA <br /> 7-- 0D OF PAYNT. <br /> CASH 0 CHECK E3 CHECK NO. TOTAL PAID SO <br /> . ,TH ME <br /> DATE <br /> -&LTp TRANS.&RE ALS <br /> ,MED CHECK-IN ATTENDANTS INITI <br /> CHECK-IN RECEIPT <br /> REDIT CARD FINDING IN <br />