Laserfiche WebLink
02!07!2014 22:47 FAX 0002 <br /> R <br /> 11 WdIITHROCKROADECEIVE, fate of Event: � <br /> RA�U CORbOVA,CA 95742 rime; <br /> ca(910351-0990 j, 1 J %l`4 Infimtd. <br /> Sawa sP <br /> 'Tinea articipntert: <br /> rnat� � <br /> ENVIRONMENTAL.. <br /> it I-I-4 rf?A I P.IT <br /> COND ONALLY EXEMPT SMA.L�I. GENERATOR WASTE <br /> CIECX N RECEIPT AND CER'T'IFICATION STATEMENT <br /> TO BE COMPLETED BY GENERATOR: <br /> I certify that the fallofiiug infonmation is emmot,and I have read and nridetstand the requirements for participation in the Philip <br /> Transportation and.R mediation Inc.Conditionally Exempt Still Quantity Generator Waste Acceptance Programs. I further certify that I <br /> atn a Conditionally Exempt S U Quantity Generator as defined by Federal and.CaiMmis State regulations,and this quantity of waste <br /> does not exceed the specified Zts for the type of waste being disposed_ If this waste is later found to exceed small quantity limits or <br /> contain rnateriats not accepted under this program,I agree to complete a hazardous waste manifest and comply with other state regulations <br /> as appropriate- <br /> COMPANY NAME: ��� COMPANY REP: <br /> COMPANY ADDREM: 115-3 Ir. E1414-#1 1S7 EPA W#: 6d7L 000 <br /> CITY,STATS,ZIE: (,t t S 76_ SIGNATURE: ' <br /> COWANY P90NE; ( TME: DATE: <br /> TO BE COMPLETED Y PHILIP TRANSPORTATION&REMEDIATION CHECK—IN ATTENDANT <br /> OFNERAL WA=GESCRE [O HAZA4n AH STATE S, HOF CONUUMM WASTE WT(LB) DISP COSI' <br /> (CMUECAL CON3Tr3tJMfr.Ptd. CLASS WASTE CDDE L C NT TYFMME AMbtWr [dRiTi <br /> MHETROD OF PAYMENT; CASH 0 CHECK CHECK N0. r S-'Z g',j!f 7 <br /> TOTAL PAID$ <br /> PHIUFTRANS&REMED CH6 -lNArMNt)ANTS INTrIALS Z DATE ��M <br /> M1407 reavasOLI CHECK-IN IIECEIPT <br />