Laserfiche WebLink
RE IVEC <br /> APR 10 2015 <br /> =311855 Wf=- POCK ROAD ENVIRONMEP i�VeR` �-��5 <br /> RANCHO CORDOVA.CA 95742 S�ct�Tu r.Cr>rpTAAr�. tme: Q a — <br /> (916)351-OM IaDrmed: <br /> MVTRONKHNTAL SERVICES Times Participated: <br /> GROUP <br /> Wca_m Region . <br /> CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR WASTE <br /> CHECK-IN RECEIPT AND CERTIFICATION STATEMENT <br /> TO BE COWLETED BY GENERATOR <br /> I certify that the following information is correct,and I have read and understand the requirements for participation in the Philip <br /> Transportation and Remediation Inc.Conditionally Exempt Small Quantity Generator Waste Acceptance Program. I further certify that I <br /> am a Conditionally Exempt Small Quhntity Generator as defined by Federal and California State regulations,and this quantity of waste <br /> 400 not exceeg the$pWffied Brits for the:type of waste being disposed. If this waste is later found to exceed small tluaaiity limits or <br /> {sno tsc4epted.under;thisfrqpan-4 J:waelo,complet"bamdouswaste manUmtand.comglywithother.statecegulations _ . <br /> as appropriate- <br /> CODUANY NAM.T: 1NeS# Lane AutOrn©tive COMPANY REP: h <br /> COMANYADDREss: 2303 West Lane EPAID#: <br /> CITY,STATE,ZIP: St <br /> _oc CtOn CA t ;,t35 SIGNATURE: <br /> COPANY PHONIC: (209) .938-0088..... TITLE: <br /> DATE: <br /> iVI1� <br /> TO BE'COMPLETED BY PIMP TRANSPORTATION &RE1V1~EIITATION CAEG'K-IN ATTENDt <br /> t M40ML M tit AH STM sf 4 O CONTAIN M WMM WT") Dw. cosy <br /> eAj. filC,. -- WAM. COBE L CONT 'tYPgq= ttxx ToiEfH <br /> Metal..Shavina 4.1 1 <br /> Processing F <br /> METHOD OF PAYMENT: CASCHECK CIIECK N0. TOTAL PAID$ 23.90 <br /> H t7 <br /> PHILIP TRANS&REMED CHECK-IN ATTENDANTS INITIALS .A" DATE t- <br /> CHECK-IN RECEIPT <br /> PSC-207 REV W1 <br />