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02/Fe 6_22. 2_016(;1,1. 31AN1Ut CA647 No. 1939 P. joaa1ooa <br /> •� - 11WWAXIBAOCHAVAD Dew ofEvone February.17,2Q7t3 _ <br /> ���« SR®YlCytie' RAN0110 COMpOVA,CA 95742 Ttmc: 11'OOem <br /> • (916)731-0980 1nPonlledl <br /> 'Ifiri" ahlclpfltcd: r I��, - <br /> CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR k(+E I til E D <br /> CIINCK-IN RECGIPTAND C1,,1UXb'ICe#FI0N STATtM ENT <br /> FEB 2 2 2.016 <br /> TO BE COMPLETED BY GENERATOR: <br /> ENTROMMENTAL <br /> I earthy that U10 following lnrormatlon is corroat,mid 1 hove rond=1 understand the requirements Lar�d[il>ifThdd?FiR413T�iF^iT <br /> Slaricyolo Conditionally Exempt Smal I Quantity(Ionerator Waite Acceptance Program. 1 further cettlry that 1 ma Coudltlonally ltxempt <br /> Small Qumitlty Cienernior as defined by redctid and Cellfbrnia Slatc rcgulntluns,nod hili tpunitlty of waste doo not oxew;d Ilio Nvoifod <br /> limits for tho type of waste being dlspnsed. If this waste Is later found to exceed iinall quontlty Ilndts nr cmntnin materials not accepted <br /> under this progfam,I agree to complete a hazardous waste mimifeat mid comply with odior stato ragelat)ons es appmprialo. <br /> COMPA, NAMEo _ n1U Auld - -. COMPANY REP: Norma Cortes e. <br /> COMNANYADDRES.v: 3128 E. Fremont St. Ernmuc CALOOQ259965 r- <br /> C1TY,STATE,ZIP; StZKton. C�,Q95205 SiGNVr11RE: _ <br /> COMPANY ritONE, (209) A04.7226 TITI-Ei Ii'IA)YY.f I� 1iATZ1 <br /> TO BLS COMPLETED BY STETtTCYCLE_ MECTC-IN 4TTEIVII ANT <br /> - - G1t}}Ha��ttAL WAPTC DM('R1pn(I.F IIAZAltb AIY...- 9'r/;f6 -91 G CU Y'Al2A?R AM . .Wt a 1l W. :t1.Yi" <br /> �CIIL'M[C CVIS IIrUll)1� wA51ti CUUIr . L 'UMI' '1'YPIt(%IY.K `. AL <br /> JOUNT <br /> uto PalInt 3 5 5 al 100- <br /> Processin Fee Y 20- <br /> METHOD OPPAYMENT: CASH I CHECK ❑ COHCK NII.- TOTAL PAID T 12nA0 - <br /> /it 0, c,) <br /> STERICYCLF.C:HI-:CK-IN ATTIRNDAN'IS INITIAJ,`; `� W..,r DATE Z 7 4 <br /> MC-207 REY 01115 CHHCI(AN R11C111P'f <br />