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<br /> � Rarrcho Callova,dt 94742 Date: a/5/xa7o
<br /> (9111351-0920
<br /> Time; 8:00 AM
<br /> CONDITIONALLY EXEMPT SMALL QUANTTTY4GENERA74R WASTE CHECK-IN AND CERTIFICATION
<br /> 1 RECEIPT AND CERTIFICATION STATEMENT
<br /> To be completed by the generator
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<br /> d o Company Name: >=eod4Less Company Rep' Jesus Jurado
<br /> TS ~ C0mPe yAddress: 21[30W Kettleman Lana EPA to# 392 349
<br /> Ladi,CA 95242 Sgnature. CA'000
<br /> Phone Number: 209-992-1463 Tifle.Com Pllanco anager Date:WW(120
<br /> MCIMPLEIDCLE CHECK•
<br /> IN ATTENDANT
<br /> 14 'J11 l� Iii' General Wase neunW-on [omacpePn, . rva. CostraiFluidwl Absorbe5gal 251bs $35.00
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<br /> _ �easmK Fee $zo oD
<br /> - :hod of pmnnt: Cash Checkk Inv Total Pald: $$5,0p
<br /> -,-.. icyde Check-In Attendants lnitlals: DBtei
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<br /> Ra-1 C Ok 957Q Date: -Of-
<br /> 11355
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<br /> 11655 Wile Rock Rd.Sterieycle
<br /> pate: 6/19/I0I0 laG�fA Time: 8:30AM
<br /> (91s11s1-osso
<br /> CONDITIONALLY EXEMF75MAL1 gIIANFITY GENERATOR WASTE CHECK-IN AND CERTIFICATION
<br /> Time: B:GOAM RECEIPT AND CERTIFICATION STATEMENT
<br /> CONDITIONALLY EXEMPT SMALL QUAN7ITY GENERATOR WASTE CHECK-IN AND CERTIFICATION To be coanpteted'by the gehe7atw'
<br /> RECEIPT AND CERTIFICATION STATEMENT
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<br /> ngernae eslaaaaa anwapr:m- Coinpary-Add—.. 24301MU2tf M-Ln LPA I04, CAL 006342349,
<br /> Company Name: Fond4Lpss Company Rep: Jesuslurado lndl,U95242 Slgnalere�
<br /> Company Address: 2490W KetGeman€ane 7PA100 CALWI)392349 Phone N—bar. 209-992-1453 Ti0e: Date:alormre w
<br /> Lod',CA 95x42 Signature: TO BECOMPLEUD BY STETCYCLE CHECK-EN ATTENDANT
<br /> Phone Number: 2.it99-1463 Title:Cwnp1'ance na0arIll E11-02p ceasral wane�e>v4oaoalrne > w� Rah aaf r�aYa _-., .. t
<br /> TO RE COMPLETED 6Y 5TERICYCIE CHECK-IN ATTENDANT fmnl4sec4h, - Ovaa fade ram- napeaarm g�/>q .tpoo-w stn Cmt
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<br /> uent aN.Wrel Crnl. Hpw5lre rinllN Tiwaaaele COSI
<br /> er Detergenr 6-1 5 1 20 6016, $24.00
<br /> ess'sg Fee C'
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<br /> �2G.60
<br /> e1d�Pylts9C Cash CY�N ��e hw TaLal'Faid` $132.0@
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<br /> inl Fee
<br /> wh.d �� d On •/
<br /> hod of Pymnt: Cash
<br /> CheCyp in,
<br /> ericycle Check-In Attendants 1plials: C - Total Paid; $30400
<br /> ^_ Date:
<br />
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