Laserfiche WebLink
S-teriude' <br /> 11855 White Rock Rd. <br /> Rancho Cordova, CA 95742 Date: 3/18/2020 <br /> p� 0 (916) 351-0980aAlk <br /> Tlle, 8:30 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 foliowing information is correct,and I have read and understand the requirements for participation in the Stericycle Conditionally Exempt <br /> mall Quantity Generator Waste Acceptance Program.I further certify that I 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: <br /> Ramirez Body Shop Company Rep: Luz Gomez <br /> :ompany Address: 1200 N. Filbert Street EPA ID # CAL 000 453 194 <br /> Stockton, CA 95205 Signature: ::]r±l --u(-Iq,x <br /> )hone Number: 209-810-8756 Title:,,; Date: .; <br /> TO BE COMPLETED BY STERICYCLE CHECK-IN ATTENDANT <br /> #of Container Total Waste Total Waste Disp Cost <br /> General Waste Description(Chemical Has. as State S/L Cont, Type/Size (gal/ft) (pounds) Meth <br /> Constituent,Ph,WTC.) Class Waste Code <br /> 3 L 3 1 gal 3 gal $10.50 <br /> 4cetone <br /> Filters NR S 12 20"x20" 3.51 lbs $13.16 <br /> S 1 1 gal 1.22 lbs $4 <br /> Bondo Dusting 4.1 .57 <br /> $20.00 <br /> Processing Fee <br /> Inv Total Paid: $48. 3 <br /> Method of Pymnt: Cash Check# ,..r <br /> Stericycle Check-In Attendants Initials: <br /> /, Date: <br /> ------------ <br />