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Steric
<br /> Ira ycle 1;655 Wlrlle Rork Rd. .CFiryrlc,- xnnrnt�c� - "r,
<br /> crdova,CA 95142
<br /> Date: 2/21/2020
<br /> CCNDIr'I),.111,1'LK, Time: 8:15 AM COIJDITI0NALLY EX1i.AT1`TSATnLL QOANTIrV C.ENER.11'fIR W'AS'fE
<br /> '1•+ll QL•4NTIT'GEFIERATOR WASTE CHECK-tN AND CERTIF)rr TION
<br /> C1;ECti-lN RL;CEII•T'qND c:RR11GICATI0N$TATf•_MEN-i'
<br /> RECEIPT f:Y1D C_RTIFICATION STATEMENT - - --
<br /> --_- __ —
<br /> _ 70 bQ cOMPleted by[hQ gQNefdtOf: T'O BE COM['LE`fED BY GE.NPRA'DOR:
<br /> -�- Fd mnl(y tlut We following inf mnasimu sod lhnw.rradwd mdertuM thr requ'v Dler particymm nik
<br /> r rrnan,�wHmsvU.- CrmrkltouallyExxmpt Smallr2 ty(ir°erator SV nate A«<puna hogrnm.IlrnrherrcntfyUwlamaCoM[on,Ilyl�unl
<br /> •••..0-, I r : '+,u rbumYr➢er•nam a, Ih�°a°t'D'Gcer as deC<d bj Fcdrnl and C,lrl mi)Starr regublioot,sod Nis quantity of wzlc dor;nd ur«A[h<•p•rifnl
<br /> Irv..<- " of w,rm s..y6,amad vuh ler tb�p tyPe orwma being duposrd H duras waste.,I,.,I 4Eb eareMsrnell gmNily It j.or coovm_O
<br /> 'Wr•n>wvNw,.xUrr.,,:y,# legram,ty ee for mplemaheardous w,t:.e manlf taM campy vnrho her nate rta IsSn-c azappr:urc
<br /> _ _C FlnvReF: Jesus/r MPA2lYNAME:�sm �-I _ _
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<br /> _ :SCEIOffCTA.aMNiIAO::ieNt[RY�8 UCL:EPA ID
<br /> l CAL OW2 Loci I__
<br /> AC,= K N ATTENDANT0
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<br /> YSTERICYCLEcH ��)
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<br /> 4 Iv <:I ....' I at '" pm • TO BE CORITLEFISD BY SZZ+RTCYCLF.CHI;ClC-IN ATTENDANT —..-
<br /> ! E.. I'n.I /hl< •Ni�<�i,C wASi➢ STATE IW /N<41Wpt WATiE
<br /> ryGy DgSCnQ[sON A]a NI
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<br /> CESQG TRACKING SHEET -� nuawROAD w<err:mr: M
<br /> ��54rkycle'g.WCHC➢RUDMYA CCA 9119; Fe
<br /> V • l916J 111-0Pa0 �'
<br /> Infarmnl.
<br /> Dwinn.Infnrman.rn
<br /> Dna HnklpnM.
<br /> CONDITIONALLY E.XEMPTSIIIALLQUANTITY GENERATOR WASTP.
<br /> rn,K Fns Il+"LhL1'r Erm.n.m.a n,J.a CHECK-IN RECEIPT AND CERTIFICATION STATEMENT
<br /> B.v.r•�n.m. F..xld..ed,r:. TO BE CONR'LE'TED BY GENERATOR: -
<br /> atnwyl Add,r.• T1pr of D..uu...
<br /> SbrlIrmlfy War ho f Ikwing W xim i,lonect.and 11—mad,nd wrdmnma the rnguhrmenrt fw pnnicly rian u Wa
<br /> rYcla CmAllbrtally F.a'empr Srtull(hunUry finenlw WnmeAvicepinma I'rognm.I fnherwnlfy Ihat I s:n a C'nMidunsll)'&mpr
<br /> 4un Addr<„Udrlln<nr foam ns,Jmg.Jdr,.. 5nra11 Qu,nJry(hnmror u d<(burl M FNemI snJ C lifvmla Stne m8ulnlivez,aM vrh Tnnrhy of w.ne dun not are<J Ua npvclfW
<br /> _ __ IImIW Rr Ora hPo of waz:—iogdiryolM.KWi,wmrebinter rormd to p<ml,m,ll llroils or<onmin m,ler:sh nrA a«r
<br /> wder Wk gmeWmmDlneahawdom wvlemnnifntm:d cwnl qunury
<br /> Drw.npmrn-- _ program,l s p y wi[h nhm ctmc mgulvuom,a appvpime. NM
<br /> 1'ypr..i U'.ar Qa,n Dn<e Tnul
<br /> COMYANYNAMK: Ran ho 58 MI I CO—R RPP:
<br /> CDMPANy ADURSTS: 14L5$,AlrpoN Wav JOSUS JOredo
<br /> PrAIM CAL 000284823
<br /> c;rv,sTArP,24P: Stockton,CA D5206
<br /> SIGN JyTjp
<br /> comPANYmoNc 1209) 332-1463 nn.m. It
<br /> PIp�rA/,-I+rr�DATE: 2,-Z-1/
<br /> ' TO BE COMPLETED BY STERICYCI,E CHECK-IN A7TENDgh7
<br /> i- Dw'ca`u`n µ inoiee , nwrNFm r w•runr
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<br /> c<" Lound 88
<br /> ~Deter enl n uaas w -11
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<br /> PA)-.MF1:'T I$DCE ON DurOSV_ W.-e m.t 1 rr 55 al 10 `rN 130-
<br /> each 61.1,•rr,[grJwrlmnr.hwn<a,rcorm[nd(nc,r rl•fyLBF trIFln �Ib! tD 140-
<br /> A1.k<rhatr p,1d.k[e�,m.,Y,ury sold w„m.wmanN' nom,w �
<br /> 7Oi.13.
<br /> SureaM FrdrN Cr:0.TFIC.ITION
<br /> A+++rduu wnee ku'Cont tlue ofCFSQG.0 c<Nkronn prugnm,to Louncs,c.rha[ In, �B6
<br /> thin 100 kilngzs,n,l boor n gall m m 2nJ116..)(IuvNoo,w.ne p<r monrh,M In,Wan I Wn grnmrc
<br /> huardow a-aa r per moarh gr.m of"nmemdy
<br /> my ugnanve bclaw amhca Jut"p ”rh<bu,mw Burd alnse W for this be,incu genrnrm k„du,.10.1 kg of
<br /> haaaadou,wm<per o,wth,nd kat dun I kg of"<aumdy hav,duw^wort per man W. '—
<br /> my mgoatrue Lwow dPm
<br /> m urd'e dot rhr wtur t am muu/am g ro thr CESQG[alkane glun wrc grnmreJ eiJun
<br /> d.sVSU'.A.—un 1'1 ort 6umnna E,md,bws W Wu 1 hart tnrmferrcd d—eauo m d,r S\'SW'A PI*M'CF r,,
<br /> p,oper"'1-00-d/.,dupe,aL
<br /> srgnnrar —
<br /> Namr/
<br /> mETHODOPPAYAIEND CASH O CHECK ClCHECK NO.
<br /> C-� TOTAL PAID T
<br /> 1 4'ih feta~k <uRlrtidala - 4.411-
<br /> ' Chat b/,Am°wl � ------ ENOAH)Y INIT7A19 f L )))///��,///
<br /> — To ln,ox�r —, �y�pUaR➢p➢WO➢I !$!] DAIM �/ >Jfl_
<br /> / l'11ECKINRECL't)rl-
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