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11855 White Rock Rd. <br /> Rancho <br /> ' J Cordova, CA 95742 <br /> CleanEafth (916) 351-09,80 Date. 2/23/2022 <br /> Time: 8:45 <br /> AAM <br /> CONDITIONALLY T ALL U <br /> REQ 9�T <br /> EXEMPSMQANTITY GENERATOR WASTE CHECK-IN AND CERTIFICATIOly <br /> ND CERTIFICATION STATEMENT <br /> Pleted by the ge�_eraC0_r._-- <br /> I certify that the following Inform --------- <br /> small Quantity Generator Waste ation is correct,and I have read and Understand the requirements for participation in the Clean Earth Conditionally Exempt <br /> Acceptance Program,I further certify that I am a Conditionally Exempt small Quantity Generator as defined by Federal and <br /> California State Regulations,and his quantity of waste does not exceed the specified limits for the type Of waste being disposed,if this"as s la U <br /> t <br /> to exceed small quantity limits or contain materials not accepted Under this Program I agree to complete a hazardous waste manifest and comply with Other <br /> state regulations as appropriate, waste I ter found <br /> Company Name. Lineae arocha@lineagelogistics,corn <br /> �eage�Iogjst�jc <br /> Company Add c S <br /> �Pany Address; Rep: <br /> 730 Spreckels Aven_U __---- Antonio Rocha <br /> e EPA <br /> Manteca cA'--- 1D# <br /> h 95336 CAL000340710 <br /> r <br /> Phone Number: Signature: <br /> 209-239-2888 <br /> TO BE COMPLETED By Date- <br /> General waste DescriptionSTERICYCLE CHECK-IN <br /> ATTENDANT <br /> Constituent, (Chemical Haz, AH State T-- <br /> Ph,WTC.) 4 f <br /> S/L 0 Container Total Waste Total Waste <br /> Class Waste Code Cont. Type/Size Disp <br /> MISC. Aer o OlCans 2.1 (pal ft) (Pounds) Meth Cost <br /> 5 CA-4 CNTR —:7— <br /> 30.6 lbs <br /> $42.84 <br /> Processing Fee <br /> Method <br /> 'fPynnt' _Cash� Ch e,Ckft� <br /> / <br /> $ o <br /> 0Cleanan EarthCheck-in Attendants Initials. Inv Total Paid: <br /> $62,84 <br /> Date: <br />