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11855 White Rock Rd . <br /> ' 3 9/ 18/2019 <br /> ; I Rancho Cordova, CA 95742 Date : <br /> " <br /> (915) 351-0980 <br /> Time : 9 : 15 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 III I I III Miss 1111 <br /> certify that the following information is correct, and I have read and understand the requirements for participation in the Stericycle Conditionally Exempt <br /> nall Quantity Generator Waste Acceptance Program . I further certify that i am a Conditionally Exempt small Quantity Generator as defined by federal and <br /> alifornia State Regulations, and this quantity of waste does not exceed the specified limits for the type of waste being disposedm 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 /> ;ompany Name : <br /> Wrenchers Company Rep : r arry Vlught <br /> :ompany Address : 540 N . Grant Street EPA ID # AL 0001 4 <br /> Stockton , CA 95202 Signature : <br /> ' hone Number : 209 -915 -2526 Title : Date : <br /> �l HE WHOM I III Miss III TO BE COMPLETED BY STERICYCLE CHECK-IN ATTENDANT <br /> # of Container Total Waste Total Waste Disp Cost <br /> SIGeneral Waste Description ( Chemical Haz. AH State ( pounds) Meth <br /> Constituent, Ph, WTC . ) Class Waste Code Cont. Type/Size (gal / ft) ( p ) <br /> NR S 3 Bags <br /> ' aint Booth Filters 15 lbs $ 21 . 00 <br /> 6 . 1 S 4 Bags 40 lbs $ 56 . 00 <br /> styrofoam Filters $ 82 . 50 <br /> > olvent 6 . 1 L 2 5 gal 10 gal <br /> lardened Clear Coat 3 <br /> MINI L 1 1 pt . 15 gal $0 . 52 <br /> HPS Lamps UW S 7 each 1 . 8 lbs $ 5 .40 <br /> 8 ' Fluorescent Bulbs UW <br /> S 10 Boxed 80 ' $ 12 . 00 <br /> OWN <br /> I <br /> da <br /> i <br /> $ 20 . 00 <br /> Processing Feeliiiiiiiiii Miss <br /> Inv Total Paid : $ 197 .42 <br /> Method of Pymnt : Cash Check# G - — <br /> Asp Date . <br /> Stericycle Check-In Attendants Initials : <br /> ! ✓�i <br /> MIAMI <br />