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SQG HW RTC Documentation <br /> Violations#38, 60 <br /> 11855 White Rock Rd. <br /> CleanEafth . Rancho Cordova, CA 95742 Date: 9/24/2025 <br /> (916) 351-0980 <br /> Time: 8:45 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 requirements for participation In the Clean Earth Conditionally Exempt <br /> Small Quantity Generator Waste Acceptance Program.I further certify that I am a Conditionally Exempt Small Quantity Generator as defined by Federal and <br /> California State Regulations,and this quantity of waste does not exceed the specified limits for the type of waste being disposed.If this waste Is later found <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. luu_tran@uniflrst.com <br /> Company Name: Unifirst Company Rep: _ Luu Tran <br /> Company Address: 819 N Hunter St EPA ID# NA <br /> Stockton Ca 95202 Signature: <br /> Phone Number: 702-325-2943 Title: /' Date: C1 <br /> TO BE COMPLETED BY CLEAN EARTH CHECK-IN ATTENDANT <br /> General Waste Description(Chemical Haz. AH State #of Container Total Waste Total Waste Disp <br /> Constituent,Ph,WTC.) Class Waste Code Sal Cont. Type/Size (gal/ft) (pounds) Meth Cost <br /> Aerosol Cans 2.1 S 1 55 gal 63 Ibs $88.20 <br /> Oil Filters NR S 1 5 gal 15 Ibs NC <br /> Seal Lead Acid Batteries UW S 1 5 gal 10 Ibs NC <br /> I <br /> Processing Fee $20.00 <br /> Method of Pymnt: Cash Check€i ��Inv � ( Total Paid: $108.20 <br /> Clean Earth Check-In Attendants Initials: l> �'rd- Date: <br /> 1 <br />