Laserfiche WebLink
St • 11955 White Rock Rd. <br /> effile Rancho Cordova,CA 95782 pate 7/10/2019 <br /> (916)351-0980 <br /> Time: 8:30 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 1 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: Big Valley Aviation,Inc, Company step: Beci Knox <br /> Company Address: 7535 Lindbergh Street EPA ID# CAL 000 034 582 <br /> Stockton, CA 95206 Signature: <br /> Phone Number: 209-982-4991 Title: ,,tib Date: _711-0100.4f <br /> TO BE COMPLETED BY STERICYCLE CHECK-IN ATTENDANT <br /> General Waste Description(Chemical Haz. AH State Sal g of Container Total Waste Total Waste Diap Cost <br /> Constituent,Ph,WTC.) Class Waste Code Cont. Typefte (Olft} (pounds) Moth <br /> Used Oil Filters NR S 3 5 gal 15 gal NIC <br /> Processing Fee $20.00 <br /> Method of Pymnt: Cash Check# y Total Paid: $20.00 <br /> 5tericycle Check-in Attendants Initials: Date: !�" <br />