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.05/03/2013 FRI 11s 37 FA,K Wool/Von <br /> REGEIVEL) <br /> RANCHO CORDO A,CA175742 JUN 2 2 2015 nate()!'ffilennc <br /> (916)351.09HO Infamic1: <br /> tuvivrllbN <br /> GROUP Bt'.ltvttat9 ENVIRONMENTAI 15n>es ratticilrsted: <br /> 4l/aamnitr�m r� T}..�r1CD�CITAAC�� <br /> CONDITIONALLY EXEMPT SMALL QUANTFIT GENERATOR WASTE <br /> CI EG 4N RECEIPT AND CERTIFICATION STATEMENT <br /> TO BE COMPLETED BV GENERATOR: <br /> 1 certify that the following i formation it currcct,and I bavc rc:ul and understand lite requirements for particiluttion in the Philip <br /> Transportation and Remediation hr- onditionaRy Rxempt Small Quantity Generator Waste Acceptance Program_ 1 further certify that 1 <br /> vn a Conditionally Exempt Sumll antity Gent:rator as dunned by Federal and Calitotnia State regulatioas,and this quantity of waste <br /> clues not c:xt wd the specified limits the type of waste being disposed. If this waste is later fotmd to exceed small quantity limits or <br /> contain materials[lot aece�ted under program,t ag=to complcte a harardoue waste manifest and comply with other state regulations <br /> as appropriate_ <br /> COMPANY NAME: COMPANY) IX: <br /> COMPANY ADDRESS: <br /> CITY,91'N1119 Gil': <br /> C.'OMPANYP114lYi:: <br /> TO BE COMPLETED BY P IP TRANSPORTATION&REMRDI4TI4 ClIECY-1N ATTENDANT <br /> GGNLxAL wASM nn9(: "MONHA7.ARn AH 3TATE 31 D OP CONTAIIm WA3'111 Wl*(Lti) u1S1! co <br /> s'r <br /> CIMACALCQh15t ru pi► c:, WAM CODE L CONT 117MM AMOtJhCf tv1CT1I <br /> MIL <br /> METHOD OF PAYMENT: CASTY CIIF,CK ❑ CII13CK NO. TOTALPAtf)S 3� ' <br /> PHILIP TRANS&REIV!'F.D CHECK- 4 ATI'P.NDANTS INPI'IALS DATE <br /> MC,W MOV11 CHECK-IN RECEIPT <br />