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�pqs <br /> I S -e2 T. -5/lfw' <br /> -icycfe� RAWAVD COU M"Alfk, CA fait: <br /> (9 f 6)3 098 0 r4ormca" <br /> Tigics 11:11TWiplW�d: <br /> CON-D r'FIONALLY Ci KEMPT SMALL QUANTUY GENERATOR IVASTE�, <br /> CHECK-W RECC IPTAND CERTIFICXFION STATEW,NT <br /> C'014PLETED BY GI-WERATOR: <br /> I certify that the fbrhc>wing information is correct. and T have read aad understand the requirements for par6cipatiou in the <br /> ,Cwycle Coaditjoaally Exempt SomaLl Quau6i�y Qf-,ucrator W&sto Acceptance:13rocTam. i Further certifytb-at f am a Cofidifioriallyr-'yerapt <br /> ,all QuariCity Geaerator as defined 5 <br /> ,med by Federal aad Califoruia State E-ogulations,and this quantity o1waste does notexceed rh6 pecified <br /> :its for the type of wastes being disposed. (f this waste is iaLcr (0k1w to exceed stnaR quantify Vimils 05 tout?cm M-Atci'ALS wcA('Mpted <br /> Jar this program,1agreeto cow etca hazzudous waste mani&st and comply with oflier state L regufatioas as appropriato- <br /> TANV UAM,- COMPANY REr.- <br /> EPA <br /> ............... <br /> S TAT ro"Z T r: S(GNATURE: <br /> WANY MOM <br /> hL f <br /> "BE CONWILFIT- EID <br /> nm <br /> An <br /> .6- 9 W R)OF =NbWM I WAM VMLS), DW, <br /> CLASS WASTS <br /> L $ 11 <br /> D P- L QQNT TWFJS= AMOMT <br /> .......... <br /> ............. <br /> I................. <br /> '800 01F P&'I)s' <br /> 'REV <br /> N4 P <br />