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rz5 ,1. 11855 White Rack Rd. <br /> Rancho Cordova,CA 95742 late: 12/18/2019 <br /> (916) 351-0980 <br /> T ime: 3:00A 11 <br /> CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR WASTE CHECK-IN AND CERTIFICATION <br /> RECEIPT AND CERTIFICATIONS ATEMENT <br /> To be completed by the generator: <br /> i,Frr,fy that the=ollo%=,ing information is correct,and f have read and understand the require merits for participation in the 5ter€cycle Condi.'�onOly Exempt <br /> NrnAI!?Quant t en¢rator U ante Acceptance Program.i f€lrthet certifV that;am a Conditiorta V Exprmpt Small Quantity Generator as def€nea by Fcderal and <br /> aliscr^.ia State? gulations,and this quantity of waste does not exceed the specified limits f the type of waste being disrosed.If this waste is later found <br /> to exceed sm�111 quant t3y limits or contain materiats not accepted under this program I agre to complete a hazardous waste manifest and comply with <br /> other state regulations as appropr ate <br /> Company Name: Optimum Aircraft Services Company Rep: Richard Knight <br /> Company Address'. 6364 Lindbergh Street EPA ID# CAL 000 359 986 <br /> Stockton, CA 95206 Signature: <br /> Phone Number; 209-983-0069 Ti le: L joe <br /> TO BE COMPLETED BY STERICYCLE CHE CK-M ATTENDANT <br /> Generai Waste Oescriotion(Chemical Haz. AH state n of Contain r Toma VUaste Total Waste Dish <br /> Constsz:ent,Ph,WTG.) Class Waste Code 5/l Crant. tviaeIsle (Sailft) (pounds) �t�tll Cost <br /> Oily Rags NR S 1 Tub 20 lbs $28.00 <br /> �. <br /> I <br /> f � <br /> ' l <br /> I i 1 I'I <br /> I i i <br /> r <br /> I <br /> _ s <br /> I rr eSSi1 �e I $20.00 <br /> µ+vi th.oci o ;oil rnt: ash CF, ck Inv Total Paid: $48.00 <br /> St&*icycle Check-In Attendants Initials: -2n � �- — <br />