Laserfiche WebLink
Ar / <br /> 11855 White Rock Rd . <br /> Ster " cycle <br /> 4� Rancho Cordova, CA 95742 Date : 11/20/2019 <br /> t ( 916) 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 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 : Heinz Seed Company Rep : Ed Krueg <br /> Company Address : 6755 CE Dixon Street EPA ID # C311000 225623 <br /> Stockton , CA 95206 Signature : <br /> Phone Number : 209-327- 0326 Title : - Dat : <br /> TO BE COMPLETED BY STERICYCLE CHECK- IN ATTENDANT <br /> General Waste Description ( Chemical Haz. AH State S/L # of Container Total Waste Total Waste Disp Cost <br /> Constituent, Ph, WTC. ) Class Waste Code Cont. Type/Size (gal / ft) ( pounds ) Meth <br /> Metal Halide Lamps UW S 18 Box/Bucket 16 lbs $ 48. 00 <br /> 4 ' Fluorescent Bulbs UW - S 1 68 Boxed 272 ' $ 40 . 80 <br /> Fluorescent Bulbs UW S 4 Tube 24' $ 3 .60 <br /> i <br /> ro $20 . 00 <br /> Processing g Fee <br /> Method of Pmnt : Cash Check##` Inv Total Paid : $ 112 . 40 <br /> z <br /> stericycle Check- In Attendants Initials : �)� % Date : <br /> I <br /> I <br />