Laserfiche WebLink
i AD' Time_ N <br /> 11855 V�HI'Y:F:R=3CI 95742 ` <br /> 0-i-4 Stericycle' RANcHo 0 RPO A, �� <br /> #t! (916)351"-0980 Times participated, <br /> CONS► <br /> ITI.ON LLY EXEMPT SMALL QUANTjTy,GFNFRAT0R <br /> ,STE <br /> C][�ECK CE1PT A.N1� CERTIF'CAT"t�N ST <br /> TO BE COMPLETES i3YENEBAT®1gr <br /> ion is correct,and I have read'and understand the requirements for participation in the <br /> IDA"- t further certify that I am a Conditionally Exempt <br /> I that:ttf� " cified . <br /> exempt.mall Quantity Generator Wastd AMA=& ° d t uanti of waste"does nbr v�he.sn� <br /> Stericycle-onditionallY limits or contain materials not accepted <br /> ;mall A Generator as tteFd by Federal and California State regulations, <br /> and <br /> quantity <br /> bei y ose& If this later d regulations as apprO <br /> l mtts fair .tylge of�ruaste �pcomply <br /> 1 writli other sta <br /> n neo- Mete a hazardous waste manifest and comp Y <br /> under <br /> O1V1pANY REP: <br /> L all <br /> J 114t '"' <br /> COMPANY NAM: '� x.. <br /> COMPANY ADDRESS: `." SIGNATURE: _ <br /> CI'L X,: TA'I.E, : - TTI I1Es24 DATE: ) �� <br /> CONgPANY PHOM- <br /> LETED BY STERICYCLE ECS�������T <br /> TO BE COMP WASTE wTt1.B) DISEcost <br /> STATE L/ CQ1F Go rim <br /> AM0171`1 f <br /> TYPFlSTZB . <br /> aENfiRAL WASTE flESCR1I'T1�1N CLASS WASTE LADE ` e <br /> CALCONS'1T117ENE Y.b. ETC. 4 t <br /> 10 <br /> per'' <br /> pato <br /> CJ -A GIS NC3. <br /> SOD OF PA <br /> YIN'r SATE `" ._ <br /> STE - CLE CHECK-IN ATTENDANTS WMALS CHECK-IN RECEIP? <br /> r <br /> pSr_207 %ZV OMIS .. <br />