Laserfiche WebLink
`0 011855 While Rack Rd, RECEIVED BY SJCEHD (EF) ON 2/25/2020 <br /> site Sivncwyde'� <br /> Rancho Cordova,CA 95742 Date: 2/12/2020 <br /> (916) 351-0980 <br /> Time: 8:00 AM <br /> CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR WASTE CHECK-IN AND CERTIFICATION <br /> RECEIPT AND CERTIFICATION STATEMENT <br /> To be completed by the generator: <br /> certify that the following information is correct,and 1 have read and understand the requirements for participation in the stericycle Conditionally Exempt <br /> mall Quantity Generator Waste Acceptance Program.I further certify that I am a Conditionally Exempt Small Quantity Generator as defined by Federal and <br /> :ali€ornia State Regulations,and this quantity 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 materials not accepted under this program I agree to complete a hazardous waste manifest and comply with <br /> other state regulations as appropriate. <br /> -ompany Name: Affordable Auto Repair &Smog Company Rep: Mashin Mohammad <br /> --ompany Address: 121 S. Wilson Way EPA ID # CAL 0'N 376 731 <br /> Stockton, CA 95205 Signature: <br /> Rhone Number: 209-462-7000 Title: C)LO APf- Date: Zlo z-C <br /> TO BE COMPLETED BY STERICYCLE CHECK-IN ATTENDANT <br /> General Waste Description(Chemical Naz. AH State S/L #of Container Total Waste Total Waste Disp Cost <br /> Constituent,Ph,WTC.) Class Waste Code Cont. Type/51ze (gal J ft) (pounds) Meth <br /> Metal Shavings 6.1 S 1 1 Ib $1.40 <br /> Processing Tee $20.00 <br /> Method of Pymnt: Cash Check# Inv Totai Paid: $21.40 <br /> Stericycle Check-in Attendants lnitials: ? Dater-- .. <br />