Laserfiche WebLink
"ilethod of Pymnt: Cash Check# ae, Inv <br /> <br />C ean Earth Check-In Attendants Initials: <br /> <br />Cc3aus. <br /> <br />CREDIT CARD ENDING IN <br />ocriS <br />Clean Earth 11855 White Rock Rd. <br />Rancho Cordova, CA 95742 <br />(916) 351-0980 <br />Date: 9/15/2021 <br />Time: 9:00 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 I 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. ginotorlai@gmail.com <br />Company Name: Lemhi Land & Cattle - Torlai Family Limited <br />Partnership Company Rep: Gino Tonal <br />Company Address: 6289 S. Wolfinger Road <br />Stockton, CA 95206 <br />EPA ID # CAL000447220 <br /> <br />Signature: <br /> <br />Phone Number: 775-815-6880 <br /> <br />Title: Date: lp-125-11U <br />TO BE COMPLETED BY STERICYCLE CHECK-IN ATTENDANT <br />General Waste Description (Chemical <br />Constituent, Ph, WTC.) <br />Haz. <br />Class <br />AH <br />Waste <br />State <br />Code <br />SA <br />It of <br />Cont. <br />Container <br />Type/Size <br />Total Waste <br />(gal / ft) <br />Total Waste <br />(pounds) <br />Disp <br />Meth Cost <br />Flora Blend 6.1 L 1 5 gal 2 gal $41.25 <br />Verde Growth Supplement 6.1 L 1 1 qt 0.03 gal $2.06 <br />Intensity 6.1 L 1 2.5 gal 1 gal $20.63 <br />Liquid Fertilizer 6.1 L 3 5 gal 15 gal $123.75 <br />Liquid Fertilizer 6.1 L 1 2.5 gal 2.5 gal $20.63 <br />Processing Fee $20.00 <br />Total Paid: <br />Date: 91/51 <br />$228.32