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Feb 26 16 12:06p p.2 <br /> REGEIV b <br /> FEB 2 6 2016 <br /> ,♦ I EBSS�tIITE ROCK ROAD pp Date ofEMA: February 17,2415 <br /> •4 0 Sterleycw RANCIiO CORDOVA,CA 95742 �1\6�� �������L Time: 10:t}Oam _ <br /> •�� (916)351-09. 1Tl_IR CJ, ._4� <br /> � ,t�- � .T lnformcd: <br /> Times Participated: <br /> CONDITIfONALLY EXEMPT SMALL QUANTITY GENERATOR WASTE <br /> CHECK-IN RECEIPT AND CERTMICATION STATEMENT <br /> TO BE COMPLETED BY GENERATOR-- <br /> I certify that the fnllov�i &information is correct,and I have read and understand the requirements for participation in the <br /> St ericycle Conditionally Exempt Small Quantity Generator Waste Acceptance Program. I further certify dist I am a Conditionally Ex=pt <br /> Small Quantity Generator as defined by Federal and California State regulations,and this quantity of waste does not exceed the specified <br /> limits fbr the type of waste being disposed. If this waste is later found to exceed small quantity limits or contain materials not accepted <br /> under this program,I agree to c�mplete a hazardous waste manifest and comply with other state regulations as appropriate. <br /> COMPANYNAME: Cast Atatomobve Repair Inc. COMPA"REP; Hector Hernandez <br /> caMPANYAUDREss: 15 N. El Dc recto EPA IW-. SAL 002268358 <br /> CITY,STATE,ZIEP: St ckton. CA 95204 SIGNATURE: <br /> COMPANY PHONE: (209) 942-3693 TITLE: <br /> TO B COMPLETED BY STERICYCLE CHECK-IN ATTENDANT <br /> GENERAL WASTE DESCWPn HAZARD AH STATE S/ i I OF CONTAINER WASTE WT(LBJ MP. COST <br /> C}Ir'.tvIICAL CONSTITUENT.Ph C.1 CLASS WASTS CODE L CONT TYFWIZB A.MOIINT _ "rm <br /> Shaved Metal 4.1 1.5 -951 <br /> a <br /> t <br /> rocessin Fee 2 <br /> METHOD OF PAYMENT: CASH ❑ CHECK ❑ CHECK NO. TOTAL.PAID 8 21.95 _ <br /> STEMCYCLECTIECK-INAFIENDANTS INITTAI.,B _._--�-- DATE <br /> PSC-"7 RUVW15 CHECK-IN RECEIPT <br /> Y <br /> `f <br /> L <br />