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05/�3/2013 FRI 11, 37 PAXQOI/44I <br /> It 855 WHt'M ROCK ROAD of PvenL: <br /> RANCHO CORDOVA.CA 95742 T : ` <br /> (91 rte 351-09Hp <br /> a: tttetrt aa�tTAa.s'at[vl <br /> lima P ed: <br /> GROUP <br /> CONDMONALLY EXFMff SMAIJ,QUANfffY GENERAXORWASTE <br /> CHECK4N RECEIPT AND CERTIFICATTON <br /> TO BE COMPLETED BY GENERATOR: <br /> I cerlify that tht following infumuition is cm=ck and 1 have rml and underftndthe requitemmts for pmtic4ation in the Philip <br /> Trurufmrhakjon and Remediation Inc CoWitioaallyt S=U QuuaW Genecator Waste Acceptanue Pwgmm. t fUrLhAlr , °fy that I <br /> am a Conditionaily lixempt Sumff Quantity tar as duffimed by Fcdcnd and Calif is Stft rWlationg,aW this quanbty o;t waste <br /> a start c=, d the 4mcified limits tX the type of wam being d` . If this waste is 111ter folmd 10 ex=d null quantity limits or <br /> coaftin materialst us►t q=it)cumpicic a huardow Waac maniftstwdcomply,with t?tttor 0aft Tegulatkolts <br /> as appropridtc <br /> e � <br /> t: '7c' ft3 PA URP: <br /> � r <br /> COMPANTADDRM: PA M#-. z <br /> =Afl. <br /> ATE. <br /> T TO BE COMPLETED BY CO <br /> PEIFLIP TRANSPORTATIONICHECK—IN <br /> U WA,%I'H (,IU tc HA7.A s 0F �tf 1A�r(t es) t31 Sr <br /> _(ClF;GEN ' LC°C1At5trltlH r,P ci W rFI <br /> e <br /> . ;` 4- <br /> e• <br /> METHOD <br /> g1 <br /> F . CAH IYQ. TOTAL PAM 3 <br /> PHILIPARTS&RF .D Cff FCK-YNATTJU4DANTS MIALS �-'t � BATF <br /> PSr-x07 RRV wlt CHECK-IN RECEIPT <br />