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� y <br /> 11855 White Rock Rd . <br /> rip ricRancho Cordova , CA 95742 Date : 11/ 13/2019 <br /> ( 916 ) 351-0980 <br /> . > <br /> Time : 10 : 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 certify that the following information is correct, and I 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 : Wrenchers Company Rep : Barry Vlught <br /> Company Address : 540 N . Grant Street EPA ID # CAL 000141564 <br /> Stockton , CA 95202 Signature : <br /> Phone Number: 209-915- 2526 Title : Date : <br /> TO BE COMPLETED BY STERICYCLE CHECK- IN ATTENDANT <br /> General Waste Description ( Chemical Haze AH State # of Container Total Waste Total Waste Disp <br /> Constituent, Ph, WTC. ) Class Waste Code S�� Cont. Type/Size (gal / ft) ( pounds) Meth dost <br /> 8 ' Fluorescent Bulbs UW S 25 Boxed 200 $30 . 00 <br /> Fiberglass Paint Booth Filters NR S 4 Bags 18 lbs $ 25 . 20 <br /> Plastic 55 Gal Drum ( Empty) NR S 3 Each 120 lbs $ 33 .00 <br /> Metal 55 Gal Drum ( Empty) NR S 2 Each 44 lbs $ 22 . 00 <br /> Processing Fee $ 20 . 00 <br /> We <br /> Method of Pymnt : Cash Check# INA Inv Total Paid : $ 130 . 20 <br /> Stericycle Check- In Attendants Initials : ' ° Date : j/ i 3 / iF <br /> _ <br />