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02 / 20 / 2019 10053 12099423670 PA 101 <br /> LAI ick Rd. tI� <br /> � Ste, <br /> ftnt p COMM% CA 95742 <br /> lt : + r .. . <br /> , <br /> QA <br /> � , . <br /> CONDITIONALLY EXEMPT SMALL. QUANTITY GENERATOR WASTE CHECKaIN AND CERTIFICATION <br /> RECOPT AND CERT4FICATON STATEMENT <br /> . , ..:. <br /> 1 certily.>:hat the ,fglla>rring ihfbilitrcltlorr is correct, and lilli readarid understand the n yuirornesti for participation in tCo <br /> he Stericgcle nditionally kXempt <br /> Small Quantify Generator Waste Aaeptance Progmm,, I further icerm that I am a Conditionally l±xemgt Small Quantlty Generator as defined N Federal and <br /> Ca Mornia State Regulations, and this yuan of wasta does ntrt exceed 4he speeffiiod Imilit s for the type of waste Heing'dlsposed, if this waste is later found <br /> to exceed small w8ntity limits or Cor<tein materials riot amept0d under this PMrarn i agree td'eomplete 3 hazardous waste manifest and comply WM <br /> otherstat2 regulations as appropriate, <br /> y Reps tBe g;ie <br /> a� y. A <br /> I ne <br /> 41dr .. 1 p .Tilli' Lem$ DC. PA, ID: #w, �CLQ�CI$�rS9� ql <br /> Stockton, CA 93206Milli 5igrt cur : <br /> Phone Number: 209-9424524 `Citic 04in <br /> j To BE COMPLETED BY $TiU CHECK-IN ATTENDANT <br /> '•ala*4m"ftm Dim Sit .d 31 bf Will <br /> _fit..,• �y� 'fes f9 }�e b • cost <br /> f � <br /> Paper Oil" Fil# ars Drained , NR S 1 S gal 141 1417 <br /> VIA <br /> list <br /> IV 1111111 in <br /> in, Inninn, <br /> It L19 <br /> I IQ <br /> ltJt 6I ►c f; 'R�/t3Yl C sfi . , ', Imr TOwl FrAid; <br /> 5tericyeie Check�ln Attendants Infttfs; pate: • <br /> 01 loll <br /> .- . • ENVIRONMENTAL H <br /> JOHN ALANIZ <br /> l�p9Y a aPV Y <br /> Fria onmi Health Spedalvl <br /> 9e <br /> 1 <br /> i <br /> R (209) 468.3147 �,'' W , ° ing,li ' Will <br /> ; Al <br /> i F: (209) 468,3433 a/ .° It <br /> i ^�- `, s -moo,• <br /> ' � jalaniz1sjcehd.corn a <br /> .= AIN <br /> 1868 E. Hazelton Aven / lr <br /> i : itorkiii n r'A QS7nS 41 �- »n�1 . . •++d; , ,� <br />