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e v Q <br /> 6 .Qs)w�'�1� ily ty t��i d"trl. usf'M�M'e -: <br /> .q,-,rjcho Cordava, CA 95711d'-1 Date: 3/16/2021 <br /> 'IeanEa�h , 17C� J 5+')Ck t%),A G' 965 ?L C() <br /> (916) 351_0930 <br /> Tinu'_: 3:15 ARA <br /> .'.7ENIERATOR. WASTEE C-HECR-IN A.MD CERTORCATION <br /> CONE-d"'I u'.to I 'A,,I <br /> RECET'I"AND C"RTIFICATION STI-%TMENT <br /> TO be completed day the generator: <br /> certifv iiiai the IS I IiIVIL:�L.W'Lf;d tjnc,iui.4 ilma ,oiuireiriam.i for pa.iidpatlDn in tiatStar!rvclQCondAiann1lV Fla-mot <br /> nasi Quantity Generator Waste Acceptance cirdf',-tiac i ar-.ir corv',',cnaliv cxer-tpt Sinall Quantity Generator as defined W Federal and <br /> alifoirria State Ragulanurth,and this 111LIal)EN-If of w..jstE-ijoc-s itoi excu,,:d thaspeLaied limiri for tile iVpi-oi waste being disposed.it this waste is later found <br /> small quantity firnit5 or contain materots acc;Fred i, fll.5 tc a hazardous waste manifest and comply with other <br /> state regulations; I;anoropriatc- <br /> 3mpany Narnl : Ramirez 60dy 511013 Company Rep: Luz Gomez <br /> - <br /> :)mpany rkdddresE�- 120-0 M Hlbort r PA I-)L CAL 000 4S3194 <br /> Srockion, CA 251_ <br /> ione Number: Date:nwyvff <br /> !_1Y STERV`1`�"'LE Al"MIMANT <br /> ienerax Wasre 11-.�cr,.pyion(Enenlical Hh' r cH Ftnrt' f rorvalne.11 'A'A W33-c• FDisp <br /> Cost <br /> Onnsduient,Ph.vv re.) f" (pounds) Poleth <br /> -atone and_?aiP_,t0_/ante gal I gal $3.50 <br /> 2.33 $3.7.6 <br /> irty Blue Shwl,Tvels lbs <br /> R�a g S 48 Ids $67.20 <br /> irty Filte,,i <br /> 9.73 lbs . 3.62 <br /> :)ndo Dust, S gal <br /> ocessing Fee 520.00 <br /> ethod of PyrrSnt- Cash J- __ Jotall Paid: <br /> ericycle Cherk-In Attendants Initials: i~ T Date: <br />