Laserfiche WebLink
1195514HMROCK MAD IIateaFEvcnt t) <br /> RA14CHO CORDO VA,CA 45742 0` <br /> (916)351-0980 - <br /> 9h'VtRO(vGiStn7Ai.ar.RViCBS - - Informed: <br /> -GROUP Wines Participated: - <br /> .lPin Rip, . <br /> CONDITIONALLY EXENPT SMALL,QUANTITY GENERATORi�t ���� �l <br /> CHECK IN RECEIPT AND CERMICAUON-STATEMEN I V <br /> ED <br /> TO BE t""LETEA BY GENERATOR- <br /> t certify that the fallowing information is correct,and I have read and understand the requirements for pare (d 11 p <br /> Transportation and Remediation Inc.Coiiditionaliy Exempt SmallQuantity Generator Waste Acceptance program. M <br /> am a Conditionally Exempt Small Quantity Generator as defrnedSryFederal and California State regulations,and this 4uantity of waste <br /> does not exceed the specified limits for the type of waste being disposed, If this mwaste is later found to exceed small quantity limits or <br /> as appropriate. <br /> contain materials not accepted under program,I agree to complete a hazardous waste manifest and comply with otber stare regulations <br /> t <br /> Cp1YT1PANYN.AME - C11t1`EZ-'f�U'tLfl _ L3 COMPANYREP: �o"'*Lc--lzv�-Vv�- e--Z- <br /> CO.tiIPANYADDRESS S_. _ 7 r/..jn_- (�- A EkAFAB: _ °-- <br /> CITY,STATE,ZIP: CRL4- -015 7-05 SIGNATMEk : -,. - . "' >- <br /> COAMA.NY PxONE: ©�I.� Z�Sc— - {3(q --- TITLE: ,r I DATE:. .. <br /> 2 P. <br /> TO BE COMPLETED BY PHILIFTRANSPORTATION&:RENI$I]IATION HECK-IN ATTENi}ifi1T <br /> CHEMICAL rON5T <br /> GP1 AL WASTEDES,JT PTION HAZARD IN <br /> AH STATE S/ p OF CONTAER - WASTE - WT(LB) DISP. COST <br /> C - - -T.- -ETC. CLASS I WASTE CODE L CONT TYPF)SIZE .AMOUNT rr <br /> 0a <br /> METHOD OF PAYMENT: CASH ¢[;' CRECK 0 CHE <br /> (/1 CK?J11. iOTALPAIDS `✓ <br /> ?HILIP TRANS&REMED CHECk-IN A. TENDANTS INITIALS — <br /> D <br /> CHECK-IN PEC>;rnr <br />