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` RECEIVED 4/11/2019 <br /> • • i 11855 White Rock Rd. <br /> ricyde Rancho Cordova,CA 95742 Date: 4/10/2019 <br /> (916) 351-0980 <br /> Time,: -8:30-Alma <br /> CONDMOMLLY-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 foliowmg information is correct,and i have read and understand the requirements for participation in the stericycle conditionally Exempt <br /> Smaitttpantlty i rtifythat-lsm7*pcnditionsUVjxlrapt-SRra#QuantityG&Wrator--As-difined-b-fedemIand <br /> California State Regulations,and this quantity of waste does not exceed the specified limits for the type of waste being-disposed.i€thiswasteis-laterfound <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 <br /> other state regulations as appropriate. <br /> Company Name: Domingo Auto Repair Company Rep: Domingo Cardoso <br /> Company Address: 545 Eden St. EPA ID# CAL 000 441 182 <br /> 'LIIdi,:CA 95.240- -5ignamm: "IX:i " <br /> Phone Number: 209-200-0629 Title:Lvlabtl Lu- Die: uc <br /> TO 8E COMPLETED 8Y STERICYCLE CHECK-(N ATTEN ANT <br /> General Waste Description(Chemical Haz. AN state #of conte aer TOW Waste Total Waste Diso <br /> Canstitupm Pl WTC) Class W astr. Code 51� Cunt. TweNte (Sal I Rj s) �Aeth Cost <br /> Oil-(Nan Contaminated)- 9 S 1 30-gal 30 $0.00 <br /> C?il Filters g. $o.00 <br /> Absorbent 9 S 1 5 gal 2.5 tb $35.00 <br /> Metal Shavings 9 S 1 l lb $1.40 <br />'rocessing Fee $20.00 <br /> 4ethod of Pymnt: Cash Check# ►nv Total Paid: $56.40 <br /> .... <br /> teriey-cte-Cheek-lmMtiendent-!i,inSLW/s:- <br />