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n <br />Date of Event: <br />T►1me: �iY't..... . <br />Informed: <br />Times Participated: <br />t �{� It � a ! +i= ` �� I i a l '�ti�! '� t " � '� I •� I I +i� I -; ''� I ! I 'r � . ! "� N': � i ��+ i". � 1 � l <br />To BE i OWi 1 I I O1 BY GENERATOR: <br />I certify that the following information is correct, and I have read and understand the requirements for participation in the Philip <br />Transportation and Remediation Inc. Conditionally Exempt Small Quantity Generator WasteAcceptance Program. I fiuther certify that I <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 />�.ywwt <br />CYMSTATEMP: <br />,,i ..REP: Gre, <br />ZPAIMM <br />TME: ' .1.� 1. d t' 1 <br />I ��i h' I r �l OIIP' 1 I ih ll `7 )'' ?,I �IJ 11 I` 'ti Z'' �i` I'•' ! E I f �i .�_ �' I �t; rl ;� +�� ^ ,_ I:I i , �I'� i I �� J <br />I� <br />ppv,, :p T?�.�`rS nc P.EMBT K.::lC.-IN � T:'Er �1�T1'u 2V <br />PSC,tc7 REV 10110 <br />CHECK-IN RECEIPT <br />