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EKWIRGENENTAL SMIFICES" <br />San Joaquin Co. HHW <br />7850 South RA. Bridgeford St CESQG DATA SHEET & WAIVER <br />Stockton, CA 95206 <br />Telephone (209) 468-5670 JOBtK &12307547 <br />Fax:(209) 468-5672 SA000048 <br />Bust nass Waiver <br />Slate and federal hazardous waste laws limit the use of this type of waste collection programs to those businesses (hat generate <br />less than 100 kilograms (27 gallons or 220 pounds) of hazardws waste per month. Businesses that generate more than this <br />amount are required by law to use a licensed hazardous "ate hauler to manifest and (ransport their Waste. Therefore, in order to <br />participate in this program. you must sign the following waiver of liability. We reserve the right to review your annual menifests or <br />consul( with the County Environmental Health Department to determine your eligibiltly for use of this program. Thank you. <br />I cantly the business that I am representing is a Conditionally Exempt Small Quantity Generator (CESQG) who generates no <br />more than 100 kilograms (27 gallons or 220 pounds) of hazardous waste per month based on an annual average end I, the <br />representative of bile CESQG. understand the maximum quantity of waste accepted at the time for disposal Is 27 gallons or 220 <br />pounds and any disposal cosh incurred shall be the responsibility of the CESQG to pry at the time of disposal. <br />Item <br />DO NOT WRITE BELOW THIS LNE <br />INVENTORY <br />(To be compkred by cD*wbon personnel) <br />Total Feel 91 lb,I Gal Prc Uns Tot. <br />Flammable Liquids - Bulk Diesel <br />17.18 146 $5.30 <br />1 $ <br />91.04 <br />Antifreeze <br />18.59 158 $1.00 <br />2 $ <br />18.59 <br />Subtotal <br />$ <br />109.62 <br />Processing Fee <br />$ 20.00ea. <br />$ <br />20.00 <br />Total <br />S <br />129.62 <br />Referred By Environmental Health <br />