Laserfiche WebLink
Zb' VAX 0002 / 002 <br /> RECEIVED <br /> t18:5 Vvl tt'I'! {' [ tC}C. ' I( 0'All <br /> s $ P' irc 4YU�ttcoGEvctar: <br /> I (A*M tin, r0, RI) 0VA , CSA9 <br /> . 957-4-?, <br /> ( 916 ) rs r- t)vfttr Garro : ; .d <br /> MAR 0 1 2019 Informed : <br /> Timcs Paiticipated : <br /> ENVIRONMENTAL HEA1 M <br /> -CO- 1 � t °IC)'NAl ; ,Y ''EE1'�f�' SMA� ,�� � � <br /> ITY GF.Nr,XE1 'I'UK WASTE <br /> C HECK4N FtEC:EIPT . i4;.N4.1 CE.R 'i.FlC;IVI3"t X .,, 'TATr4;M., 'Nils <br /> Wool TOIBE CNau'LETED BY -GENERA'7'Ok:; <br /> I certify that the Following information is correct , and i have readgrid iitiders(aud the rcyuiremdttts for puticipatiou it ) the <br /> Lxeutpt Small Quantity Gurncrator 'Waste Aeco ptauce Program . I further certify that I am a C onditiouaity I✓ xempt <br /> 5tcricycle GonditionalIy <br /> Si3lall Quantity G(,% 1wrntoz Is de;fulcdl 17y FcdMll iriid' C:aWbruin State rugulations , and this quantity of waste does not exceed the specified <br /> limits for the type of waste being disposed. I f this wash Is layer found t0 CXCCi d sI> ta�l, c watbtYty Is> tats or. contain pCt .Tlle'I evLial4 not acsapt'e d ' <br /> under. Us, programs l II&T to errrr�Ir�ete : a ssit^cicrr,a wwu inatuf6st an,docomply wlifrtn tsLri •-stat7tgn18>:fons 'fl5: spp'r40pIhte <br /> COMPAN `<' NAtVIE : rtt ���LL 1ndWnal OC�� Y� COMPANYREP : � C -- <br /> COMPANY ADDRESS : , . 0 106 (--��T ( p�A �> `r' <br /> EPA Ibtt ; ' to <br /> CITY, S' 1'A,TF, Z7P: > _ <br /> fiIY; NA.';t't.IRE: <br /> COMPAN S( k'HONE : ( 7�° _ •�- ,rE <br /> z �_- <br /> I3E ( } PLE T� 4ST'ET ICYT T •� . x: HEC. -xI 1 ". 'TE, A 7T. <br /> C; HNI { RA1 . wASTCI') 1 :,4 ( : ItJP' I ' i (,)) t <br /> _ , ItAZARD t;..Ts...A_) 1I : <br /> I , taJ7!N_iCCattn91l :Af , ( (>NSTIT' UI ;N ' 1 ' h ETC ) ' I ' t llY <br /> lwAst } WT( LD) ) Itil� ( cti' Ii.Atix ' <br /> p ist �i : ntvtc ) tiN' r <br /> Losee <br /> A�. <br /> ININ <br /> Vni"MCDOFPAYMENT; CA8I1 El CHECK � (210- EC:fC ,t?I( I_ ._ . � �` <br /> 1UTAyI � P [J�. 119VI <br /> iTF.RtI-: Y(. LF.:ClI-iL:•l':K INATT F.NI *vA+N?j `_aj-NtjTI:L\ [ S <br /> ARV rwII - <br />