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^ � x 11855 White Rock Rd. <br /> 5-Aencycle., Rancho Cordova, CA 95242 Date: 5/18/2019 <br /> (916) 851-0980 <br /> Time: 9 :15 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 /> certify that the following information is correct,and I have read and understand the requirements for participation in the Stericycle Conditionally Exempt <br /> nail Quantity Generator Waste Acceptance Program.I further certify that l am a Conditionally Exempt Small Quantity Generator as defined by Federal and <br /> alifornia 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 /> :ompany Name: Wrenchers Company Rep: arry Vlught <br /> :ompany Address: 540 N. Grant Street EPA iD # L 0001 4 <br /> Stockton, CA 95202 Signature: <br /> 'hone Number: 209-915-2525 Title: Date: <br /> TO BE COMPLETED BY STERICYCLE CHECK-IN ATTENDANT <br /> General Waste Description(Chemical Haz. Ata State S/L #of Container Total Waste Total Waste Disp Cast <br /> Constituent,Ph,WTC.) Class Waste Code Cont. Type/Size (gal/ft) (pounds) Math <br /> 'aint Booth Filters NR S 3 Bags 15 lbs $21.00 <br /> styrofoam Filters 6.1 S 4 Bags 40 lbs $56.00 <br /> >olvent 6.1 L 2 5 gal 10 gal $82.50 <br /> -iardened Clear Coat 3 L 1 1 pt .15 gal $0.52 <br /> HPS Lamps UW S 7 each 1.8 lbs $5.40 <br /> B' Fluorescent Bulbs UW S 10 Boxed S0' $12.00 <br /> Processing Fee $20.00 <br /> Method of Pyrnnt: Cash Check# %° Inv Total Paid: $197.42 <br /> 5tericycie Check-in Attendants Initials: Date: �„! <br />