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Rancho Cordova, CA 95742 date : 11/6/2019 <br /> (916) 351-0980 <br /> Time : 9: 15 AM <br /> CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR WASTE CHECK-ISI AND CERTIFICATION <br /> RECEIPT AND CERTIFICATION STATEMENT <br /> To be completed by the generator : <br /> [ certify that the following information is correct, and I have read and understand the requirements for participatio in the Stericycle Condition Ily Exempt <br /> Small Quantity Generator Waste Acceptance Program. I further certify that I am a Conditionally Exempt Small Quantity Generator as defined by Federal and <br /> California State Regulations, and this quantity of waste does notexceed the specified limits for the type of waste being disposed . If thiswaste is laterfound <br /> to exceed small quantity limits or contain materials notaccepted under this program lagree to complete a hazardous waste manifest and comply with <br /> other state regulations as appropriate. <br /> Company Name : JKC Trucking Company Rep : Malisa Rose <br /> Company Address: 3400 Newton Road EPA ID # CAL 000 405 278 <br /> Stockton, CA 95205 Signature : <br /> Phone Number: 209-489-2457 Title : Date: <br /> TO BE COMPLETED BY STERICYCLE CHECK-IN ATTENDANT <br /> General Waste Description (Chemical Haz. AH State # of Container Total Waste Total Waste D;sp <br /> Constituent, Ph, WTC,) Class Waste Code SQL Cont. Type/Size (gal /ft). (pounds) Meth COSI <br /> Empty Drum ( L.C. Oil ) NR S 1 55 gal $ 11:00 <br /> processing Fee $20 :00 <br /> Method of Pymnt: Cash Check# Inv Total Paid: $31 . 00 <br /> Stericycle Check-In Attendants Initials: Date: <br />