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11855 White Rock Rd . <br /> err. <br /> ot <br /> wp <br /> Rancho Cordova , CA 95742 Date : 2/26/2020 <br /> (916) 351 -0980 <br /> Time : 8 :45 AM <br /> CONDIT 'IU VUL V x "71 :'IAPT f i SIA QUANTITY %XNERATOR WASTE CHECK- IN AND CERTIFICATION <br /> _ RECElP'r ACAD CERTIFICATION STATEMENT <br /> To be completed by the generator : <br /> i certiry drat toa fodowi jg ; n �vr-. . al is cur (ecc, and i have read and understand the requirements for participation in the Stericycle Conditionally Exempt <br /> Small Quantity Generator Waste Acceptance ^ ' 1ogr:: rn . I fur- rar carti v: hat ! am a Conditionally Exempt Small Quantity Generator as defined by Federal and <br /> California Stag nc�Uiatiuii5, and rhes quariiiiy of waste does not exceed the specified limits for the type of waste being disposed. If this waste Is later found <br /> to exceed small quantity limits or contain materia :s not accepted under :his program I agree to complete a hazardous waste manifest and comply with <br /> other state regulations as appropriate : <br /> Company Name : Yvu �•tg ' s Ace Hardware ; Company Rep : Rindy Crawford <br /> MAX _ a-._,. _� � _ _.y _. - - -- <br /> Company Addres .s : 18960 N . HWY 88 EPA ID # CAL 000 402 175 <br /> Locke tsrd, CA 9523 ; ; Signature : <br /> 4k . - <br /> y <br /> Phone Number : 209 -727- 3791 Title : Date : Z - Z ( A. Z <br /> �sNot <br /> TO BE COMPLETED BY STERICYCLE CHECK- IN ATTENDANT <br /> General !hraste r)esei� �?inr, ; C ';� r,, ;ra � ! ! az . i AH I State b of Container Total Waste Total Waste Olsp <br /> S'/� Cost <br /> Constituent, Ph, UJi'C . ) !', � i '�1+jsta Cada Cont. Type/Size (gal It) ( pounds) Meth <br /> Chain SFiarv ! s-dng Dust ; . 1 ; S 1 1 qt . 25 lbs $0 . 35 <br /> Key Shavings u . :f S 1 1 qt 1 Ib $ 1 . 40 <br /> Aersoas -� ^ i }s S9 Varied :7 . 25 lbs $ 10 . 15 <br /> Paint � _I L 6 Varied 2 . 75 gal $9 . 63 <br /> CFL5 — _ - ,. ` . irV y �� S 3 Each $ 3 . 75 <br /> Absc1 berm , J/ Ail -` it/ I C 1 I� 1 sag 4 lbs $ 5 . ti0 <br /> PoSyber d 6c• , rt f Bags 56 lbs $ 78 .40 <br /> Suregrip Activator 1 F�1 gal 1 Gal X8 . 25 <br /> Paint/Primer its Oki �� 1 1 pt . 15 gal <br /> _ ,. . $a . ri2 <br /> Wcod Sqtza ' 1 . I 29 oz . 23 gal 57 . 81 <br /> Cerner: t t : i , ! F1 gal 2 gal ,� am . 50 <br /> -- -- <br /> Prim r2r ! I 1 gal 1 gal <br /> Antifrt � � U — � ! . � � _ i r �. I 1 gal 1 gal <br /> � <br /> 3 <br /> - ��-- --- � - - 32 oz . 25 gal :7J . � <br /> Pahl , IAM � ' ar� t � UYI 1 � 1 I = 17a1 1 gal <br /> . <br /> �ZAOJL A- <br /> ChZin Lub 1 ^ 1 1 _. I l r - 1 gal 1 gal <br /> _ _ t3 . ? 5 <br /> . . - _ . . `__ 1 I --- - — - <br /> � i oC� Sslri;?. : . . . y � . f <br /> A t__ <br /> Method oi ? venni : Cash 11, Total Paid : f7i . 24 <br /> SterirYrl ✓ ' n � ' In rt � ndr, nt � Ir. dais : i Date : .�; ✓f9e <br /> - - - <br />