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11855 White Rack Rd. <br /> rancho Cordova, CA 95742 Date: 11/3/2021 <br /> Clea-nfafth : <br /> (916) 351-0980 <br /> Time: 10 -0-0 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 /> I certify that the following information is correct,and 1 have read and understand the requirements for participation in the Clean Earth 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 other <br /> state regulations as appropriate. hewittaline@gmail.com <br /> Company Name: Hewitt Alinement Service Company Rep: Samantha Esposito <br /> Company Address: 925 S. EI Dodado Street EPA ID# CAD983641093 <br /> Stockton, CA 95206 Signature: <br /> Phone Number: 209-948-8433 Title: Date: /!-0 3—° 0 2 <br /> TO BE COMPLETED BY STERICYCLE CHECK-IN ATTENDANT <br /> General Waste Description(Chemical Haz. AH State S/l. #of Container Total Waste Total Waste Disp Cost <br /> Constituent,Ph,WTC.) class waste Code Cont. Type/Size (gal/k) (pounds) Meth <br /> Fluorescent Bulbs, 4' UW S 11 Boxed 44 Ift $6.60 <br /> Fluorescent Bulbs, 8' UW S 12 Boxed 96 Ift $14.40 <br /> Lead Acid Batteries UW S 5 Units 59 lbs N/C <br /> Brake Fluid 6.1 L 1 5 gal 3 gal $41.25 �d <br /> Metal Shavings 6.1 S 1 1 gal 1.5 lbs $2.10 J <br /> Grease 6.1 - S 1 5 gal 84 lbs $117.60 <br /> Grease Sweep NR 1 S 1 5 gal 36 lbs $50.40 <br /> Oil Filters NR S 30 each N/C <br /> Alkaline Batteries, Various UW S 59 Units 4.49 lbs $3.14 <br /> Nickel Metal AA Batteries I UW S 24 Units 1.65 lbs $1.16 ✓ <br /> i <br /> � I <br /> l <br /> t i <br /> F <br /> Processing Fee ' # $20.00 <br /> Method of Pymnt: Cash Check# Inv ITotal Paid: $256.65_ <br /> Clean Earth Check-In Attendants Initials: Date: <br /> w <br />