Laserfiche WebLink
-uTICA) 0 <br /> _ (D 1 CD <br /> W 2 W E <br /> W_ 1 -n D <br /> Nm c <br /> M �D N 3 o <br /> r,� o <br /> Stericy�cT L <br /> 11855 White Rock Rd. <br /> Rancho Cordova,CA 95742 <br /> ''Y`OARre)r-:atj'ytl,,. (916)351-0980 Date: 3/20/2019 00 0 O <br /> � O <br /> CONDITIONALLY EXE 0 0 <br /> MPT SMALL o <br /> QUANTITY GENERATOR W Tlme: 8.a5 AM W � <br /> RECEIPT AND CERTIFICATION ASTE CHECK-IN AND CERTIFICATION > <br /> TION STATEMENT D <br /> To be completed b (n co <br /> certify that the following; by generator: N <br /> Small forma is correct,and I have read and understand the requirements for O <br /> Quantity Generator Waste Acceptance Program.I further certify that a <br /> California State Regulations,and this u W Ul <br /> q antit Panic ipation in[he 5terlcyde Conditionally Exempt < <br /> to exceed sma)I Y of waste does not exceed the specified m a Conlimit,for Exempt Small quantic Genes N <br /> quantity limits or contain materials not accepted under this pro limits for the t e f y otos as defined by Federal and <br /> isposed if <br /> Brae to complete a hazartloueing swaste manlfes and comPlYrwl[h� (D <br /> other state r gram I° his (D <br /> Com an egulattons asappropriate. <br /> p y Name: Centu <br /> rY Con <br /> mpay Address: Auto Q <br /> 3128 E Fremont St. C°mpanyRep: <br /> Norma Cortes � <br /> Stockton,CA 952D5 EPA ID 4 CAL 000 2 96 _0 <br /> Phone Number: Signature: O <br /> 209-922-9146 <br /> Title: N <br /> TO BE COMPLETED BY STERICYCLE CHECK-IN ATTENDANT Date: _ 0 <br /> General Waste Description(Chemical Hoz. AH State o <br /> Constituent,Ph,WTC. Class 4^taste Code SA Container Totalwaste Totaiwaste Dap <br /> coni. TYPe;Sae <br /> SE-alihi eth °St (n <br /> Paint and Thinner Mix 3 (Pounds) ML 5 gal ®. <br /> I <br /> I <br /> 520.00 <br /> Processing Fee <br /> � <br /> Method of Pymnt: Cash Inv Total Paid: <br /> Check# _ q(, -- <br /> Date: d.y <br /> Stericycfe Check-In Attendants Initials: <br /> JO <br /> cD <br /> 0 <br /> a <br /> cQ � <br /> cD m <br /> o_ o <br /> Ln <br /> N N <br /> W <br /> Cn <br /> V <br /> O <br />