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i <br /> 0.6 11855 WHITE ROCK ROAD Date of EVcnt: August 11, 2016_ <br /> ®0 Stericycle' RANCHO CORDOVA,CA 95742 Time; <br /> (936)351-0980 Informed: <br /> Times Participated: i <br /> I <br /> CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR WASTE <br /> CHECK-IN RECEIPT AND CERTIFICATION STATEMENT <br /> - TO BE COMPLETED BY GENERATOR: - <br /> i <br /> I certify that the following information is correct,and I have read and understand the requirements for participation in the <br /> Stericycle Conditionally Exempt Small Quantity Generator WasteAcceptance Program. I further certify that 1 am a Conditionally Exempt <br /> Small Quantity Generator as defined by Fcderal and California State regulations,and this quantity of waste does not exceed the specified <br /> firaits for the type of waste being disposed. If this waste is later found to exceed small quantity limits or contain materials not accepted <br /> under this program,I agree to complete a hazardous waste manifest and comply with other state regulations as appropriate. <br /> COMPANY NAME: - Associated Tractor COMPANY REP: Ruth/ Boomer — <br /> COMPANYADDRESS: 1323 W. Charter Way IEPAID#: NIA <br /> CITY,STATE,ZIP: Stockton, CA 95206 SIGNATURE: <br /> COMPANY PHONE: (209) 466-3003 TITLE: DATE: _ ---- <br /> TO BE COMPLETED BY STERICYCLE CHECK-IN ATTENDANT <br /> GENERAL WASTE DESCRIPTION HAZARD AH STATE S/ 4 OF CONTAINER WASTE WT(LB) D1SP. COST <br /> (CHEMCA_L CONSTI I-UENT.Ph._LCCJI CLASS WASTE CODE, 1, CONT TYPF./STZF AMOUNT _ METH <br /> Batteries = _�._.. _ - — - 32 22-4_ <br /> CFL - - 4 4. 10 <br /> _ ( <br /> Processing dee - - --- -- - — —- - 20- <br /> k <br /> METHOD OF PAYMENT: CASH ❑ CHECK 0 CHECK NO, TOTAL PAID$ 46.80 l <br /> STERI CYCLE CHECK-INATTEN,DAN I'S WT"I'IAI,S _...�_ . DATE <br /> p <br /> rsc-2m UVOV15 CHECK-IN RECEIPT <br /> i <br />