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.l m <br /> 0. <br /> 02 0o C <br /> t <br /> -D <br /> N (D C <br /> M <br /> Cl) _ <br /> CD O O <br /> #7 Steric ! - 11855 White R <br /> ��I� Rancho ock Rd. <br /> Cordova,CA 95742 O. <br /> (916 351.0980 Date: 3/Z0/2o19 C) <br /> O <br /> CONDITIONAL�y EXE 7 � <br /> MPT 5 � O <br /> MALL QUANTITY Time: 8:45 ANI > <br /> GENERATOR WASTE CHECK-IN AND CERTIFICATION <br /> RECEIPT AND CERTIFICATION � n <br /> STATEMENT D <br /> To be complet�byN cn <br /> e generator: cn <br /> l certify that the or: <br /> inforrnauon a ccrr.. N <br /> Small quantity Generator tv.s[e q- < a- �'" - ^� <br /> w 01 <br /> Cafiforma State Regulations,and to s• >Nrtm l f�rtt tih�th .� "'" <br /> IUaniit'/'Jt�l•d��. -1 aCt; d 'U' t ., , <br /> to exceed small quan[iry t dor• c;ezceed l-� v f x Pt-'^,;,r, -- ' (D <br /> lim7ts or con tam ma -ac;fHy i is for the t a .t `"`` •-.. <br /> terrafs no:accepted underth: YPe ofwa;te " ---'- �" <br /> Programlagreo to camvletcah Hdspu: ,..� - ,.e.r.�r.J (p <br /> =then State n+""Cons as aDP,o.r a e. 40(dow wa)Lc mo�tletdnd l nPly with (D <br /> Company Name: <br /> Century Auto :3 <br /> Company Address: _ Company Rep: CL <br /> 3128 E Fremont S;. _- _ Norma Cortes y <br /> Stockton,CA 95265 EPA iD CAL Goo 2 96 _0 <br /> Phone Number: Signature: <br /> 209-922-9146 <br /> Title: CD <br /> TO HE COMPLETED BY STERICYCLE <br /> Q- <br /> CHE[K-IN ATTENDANT <br /> O <br /> General Waste Description(Chemical ria:• A-! State _ _ <br /> Constituent.Ph,WTC) Class :qac o' -- r <br /> 5/i °^E' !ctarv,•-,-sm ?otalWaste Dew <br /> Code -�- - - CCs? � (n <br /> a �.. ipovndsi ut, <br /> Paint and Thinner Mix 3 L `" gal , m <br /> n. <br /> ancf st — 0 <br /> _ r�D <br /> 520.06 <br /> Processing Fee <br /> Method of Pymnt: Cash Check# <br /> Inv Total Paid: <br /> / Date: <br /> Stericycte Check-In Attendants Initials: •' <br /> f' <br /> qf' <br /> 1 CD <br /> n <br /> T Q <br /> v <br /> -4l <br /> Q O <br /> Cn <br /> N N <br /> W <br /> CA <br /> J <br /> 0 <br />