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atencyck <br />. s iu:15;f' S <br />11855 White Rock Rd. <br />Rancho Cordova, CA 95742 <br />(916) 851-0980 <br />Date: 9/11/2019 <br />Time: 8:45 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 />1 certify that the following information is correct, and I have read and understand the requirements for participation in the Stericycle Conditionally 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 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 />Company Name: Wesco Graphics Company Rep: Mike Maechessault <br />Company Address: 410 E. Grantline Road EPA ID # CAR 0001.04 901 <br />Tracy, CA 95376 <br />Signature: <br />Phone Number: 209-832-1000 Title: Date: 14 <br />e - <br />TO BE COMPLETED BY STERICYCLE CHECK-IN ATTENDANT <br />General Waste description (Chemical <br />Constituent, Ph, WTC.) <br />Haz. <br />Class <br />AH <br />waste <br />State <br />Code <br />5�L <br /># of <br />Cont. <br />Container <br />Type/Size <br />Total Waste <br />(gal / ft). <br />Total Waste <br />{pounds} <br />wisp <br />Meth <br />Cost <br />8' Fiourescent Tubes <br />UW <br />5 <br />63 <br />Boxed <br />504' <br />$75.60 <br />4' Fluorescent Tubes <br />UW <br />5 <br />92 <br />Boxed <br />368' <br />$55,20 <br />Processing Fee <br />$20,00 <br />Method of Pymnt: Cash Check# h , �4 Inv <br />Stericycle Check -In Attendants Initials: <br />Total Paid: <br />Date: 1301--1 <br />