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.. �. . -� �... ... �.. ...., Wvvii vvo <br /> EEIVE <br /> ; <br /> t• - 11855 WHtr7i ROCK ROAD mite 0f F-A- Febmw 10,2416 <br /> i i� Stlgriee�c# uk'?!�?w!'^?t«?rn�yTr� nrte:! FEB 12 20x6 ;:ti:.b. Wpm <br /> • (916)15t-09R0 Inrornfed- <br /> ENVIR0N SRM X <br /> CONDITIONALLY EXEMPT SMALL.QUAWI'I'X CENERA7'OK WA.,q`i'F <br /> CHECK-IN RICCEI'rrAND(MRTIFICATION STATEMENT <br /> TO BE COMPLETED HX GENERATOR: �.�..�.-Y�------------ <br /> i certity that aw jbhow0n lnionndtion is conn,and i have read and understand the requirements tar participation in the <br /> Slutirysic cunditiunaity Exempt Small Qurnl'dy Ga=a(Qr WaouAcccpttmct:Progmi- I iurdW ratify lust i stn 8 C011did0n211Y Exempt <br /> Small Quantity(generator as defined by Federal and CaGfanda Spee regulations,and this quantity of waste does not exceed the specified <br /> liths ibr the tape of waslc ltehig dls If tkHs.wsstc is latex fu�cl t5i eusyuaJ etmnll cpttmt r limiss ttr vs ntraiel�tit a epkect <br /> under this program,I agree to complete a he-cardona waste totlifesi and comply with other mate regulations as appropriate. <br /> COMPANY NAME.; Portside Machine Shop, Inc. <br /> COMPANY IIEP; ,loan. ... <br /> COMPANY ADDRESS: 1704'W 68M'Ont St, UPA 1D#' _ 16 � <br /> CIT,STATY,7.7: Sto #tt3n. CA 9520 <br /> COMPANY PHONE, (209) 463-4893 IMUL DATE: <br /> TO RT C t7MPLETED D'Y S'CImim' cu CHECK-IN ATCENDANT <br /> GENE RAi.wASTR nMEAt7noN HMAIM WAS^ <br /> STATS top b:t n BAR a► 'w ttLflt � txt� <br /> ,ICA:, r - - - <br /> tainiess St i PoWde / 4.1 l 1' 2.47 <br /> - --- ---- ---- <br /> DustrQcewing <br /> F _ 20- <br /> METHOD OF rAYMBNT: CA311 0 CHECK D CHE_CXNO. �V IDTALPAID$, 22-47 <br /> STF.RICYCLE CNEcmN ATrmuiANTS INITIALS C/ DAW <br /> CHEE=K-iN RECEIPT <br /> VB(:307 Lth'vOt/iS <br />