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11855 White Rock Rd. 2/16/2022 <br /> Rancho Cordova, CA 95742 Date: <br /> CleanEat <br /> �"'�' (916)351-0980 <br /> Time: 9:15 AM <br /> CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR WASTE CHECK-IN AND CERTIFICATION <br /> RECEIPT AND CERTIFICATION STATEMENT <br /> TO be completed by the generator: <br /> I certify that the following information is correct,and I have read and understand the <br /> Condigt onall eExemptparticipation <br /> antitythe <br /> Geneclean <br /> rator as defiinedConditionally <br /> deral and <br /> small Quantity Generator Waste Acceptance Program,I further certify that I am a y e of waste being disposed.If this waste is later found <br /> California State Regulations,and this quantity of waste does not exceed the specified limits for the typ <br /> to exceed small quantity limits or contain materials not accepted under this program I agree to complete a hazardouas waste manifest <br /> andtics.corn with other <br /> state regulations as appropriate. <br /> Company Name: Lineage Logistics company Rep: Antonio Rocha <br /> 340 <br /> Company Address: 730 Spreckels Avenue EPA ID # <br /> Manteca, CA 95336 Signature: <br /> Phone Number: 209-239-2888 Title: Date: <br /> TO BE COMPLETED BY STERICYCLE CHECK-IN ATTENDANT <br /> General waste Description(Chemical Haz. AH State s/L #of Container Total waste Total Waste Disp Cost <br /> Constituent,Ph,WTC.) Class waste Code Cont. Type/Size (gal/ft) (pounds) Meth <br /> I--- <br /> Rechargeable Batteries UW S 30 Boxed 44 lbs $66.00 <br /> LED Light UW S 4 Boxed 28 lbs $84.00 <br /> ower Tools EW S 5 Boxed 37 lbs N/C <br /> _fight Fixutre NR S 1 Boxed 29 lbs I $40.60 <br /> Light Bulbs UW S 15 Boxed 5 lbs $15.00 <br /> (Fluorescent Bulbs, 4' UW S 30 Boxed 120 Ift $18.00 <br /> Processing Fee $20.00 <br /> Method of Pymnt: Cash Check# f f a Inv Total Paid: ,x,243.60 <br /> Clean Earth Check-In Attendants Initials: vl Date: -+✓� . 7 <br />