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0y5tericyck .'ft'h°o6� 9`S7-42 nate: <br /> fnwaNHNdaf$p8dgna <br /> �trssmm>3Ro«,LOAD oma orA.�rc Novamber9 2016 <br /> Time: <br /> •�� Sterf[ycle' IiAIVCf10 CORWYA G.95]43 nmo- 9:OOnm <br /> taivessiasao mwrmaa: CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR WASTE CHECK-IN AND CERTIFICATION <br /> nmea pwnapmW: RECEIPT AND CERTIFICATION STATEMENT <br /> CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR WASTE To be completed by the generator: <br /> CHECK-IN RECEIPTAND CERTIFICATION STATEMENT <br /> ce�etvrN[dwfolbvdryt inbrmarbn a cmmet,antl i Nvo reaa antl anderstantl lhezeauiramerm Tor pertk'rparbn inthe Scerkvcle Condlnonelly[tempt <br /> TO BE COMPLETED BY GENERATOR: smanonamlwuamamr waauacnpdrcePmrram.iwmnmrenlry mtt am a camnbnalry caemptsMafl ouantltycaremmr bdenaad M vadrrat apd <br /> ate 2qubtkxu,anatFb qua,M1iry Mwawe does rut eueea+N spxrflaf rrmN toraNtype mwaue bN�gatepased.lf tniawasle'ulater found <br /> m eaceeasmaHgrentrty amazarewnam matedalsnINxraRted wader thb Wogram larreetp mmplxe a Nzardmcwam maMfezt and wmprywM <br /> I mdiry Nat me f apt i 11 Q.—m G rptmat and I Nave read and undemland 0a requbaneab for plucicipffiiog N the otew tae rexAatlonr as apprpprfine. <br /> Steicycle Cpntlin'orelty @emptSmeli Quantity Gmamtp WuteAaxapknee Program.ifurther percify Ih&t eta aCondiNmaliy P¢mot <br /> SmallQusotiry Ganmamr I da&MfiyPdud end Califgmia Skk pp.M.. P F ress:regulations,eedd,i,,emdryofwnstadoea noe axcaed Ne specified Company Name: FHad4teas(W Rat&man Lnj Company Rep: Jesus JDrado <br /> limits for the type of—being diaP ed.If Nis wazm is later fmmd a aamrd smaller slate—1.6—iom na grmptiry limit.o<=onkin mptcriaA mt scrapes Com an Add2430 W Kettleman Ln. EPA 10# CAL 000 3952 349 <br /> under tdia My ,l agree to cMpleW,hemdout weak meeifeal and_Ply with othe <br /> Stockton,CA 95242 Signature's y <br /> Phone Number: 209-992-1463 Titl pflpr Date; 1 <br /> C WANrANYNAME: Food-¢Less COMPANY REP: JBsus Jurado TO BE COMPLETED By STERICYCLE CHECK-tNA NDAM^'�7° <br /> coMPAAABEss: 2830 W KettleJn L EeAIDx: CAL 003 49 <br /> CM,,STAMZW: Lodi,CA95242 stcNATpBE: 6amat waab er rbt�mrttabmtd tsar. Att srxt Ppr �a.�e ®,wanp <br /> CWMPANY PAONE: (2D9) 89-iq6_� 3 - —LE:CO ! DAT$ C°^fie<Ph,wrL) i� arab �a �pL ayq®'sea f{ed/Ri (Wwm) tdcnn CST <br /> Powder Detergent Be S 2 I <br /> TO BE COMPLETED BY STERICYCLE CHECK-IN ATTENDANT <br /> t fi@rERN.WASrB IYiSCRIPlIGN t1AZARD AH SSATC & IOF WNfAmCR WASTE Wi11.AJ 'DISP <br /> C fu °-ASS WASfB WDC FTPF¢6 /SMrUNI' Mg'YH C� <br /> Laund Deter ent 813 i I 100 130- <br /> Aerosols 2.1 1 2 al 35 5.5 <br /> Pf— S F -- <br /> :sine>S4 <br /> ME IZO OFP 20- tlofPymnt: Cash $ <br /> ENT: CASH p CHECK q CNECK Mo. [hectA �,�, QR f IZJnv <br /> TOTALPAID5195.50 :le Cheek-In Attendants lnftlafs: t,D 2.00 <br /> ST6ni SC K-ItdATTENOANTS MITIALS Date: <br /> ev Igb7 DATE �r�—/1. <br /> �g� �PA'aq CRECK4N RECEIPT <br /> V <br /> a <br /> m <br /> a sz m N <br /> 8 E P°�a <br /> = [ o o s oho e <br /> a� 3 s a' 0 m r <br /> N <br /> Y y <br /> o� mti� <br /> So <br /> p3 n �T <br /> z ❑` ro ° wml <br /> =a <br /> L3N m y <br /> ��e Lao aaD O <br /> o mDN3 <br /> j;Nps�AeM <br /> m pmMO <br /> u�o I ,�rFA <br /> e050 <br /> • <br />