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Harbo <br /> }_ �pf1Y! 1��4N��EM�TILL 3ERYIC&S' <br /> 5sPJo6Qu :hiiiW 1 t00 YO�i <br /> 765o South RA 9ridgefdrd St CESQG DATA SHEET &WAIVER <br /> Stockton,CA 95206 JOBM 6,12461336 <br /> Telephone(2M)4665670 SA000046 <br /> Fax:(209)468-5672 <br /> BesNnes srlbre ewn <br /> company Nwne: Mecca E ul ritent Can y Ropm <br /> street Addiesa 7930 C E Dixon <br /> E-mail', <br /> Coda: Stockton Ca 86206 on=e code x ra , rt. 309-963$790 <br /> Arae Cads&Fax Number <br /> eaflnel5 yyaher <br /> Sate and federal hazardous waste Im+s grrnit me use of this type of waste cdtacgan propmms to moan buslnessea mat generate <br /> less man foo ktlgrams(27 getlorr or 220 pounds)of hazardous wsate Per month.Businesses that generate more then this <br /> ste hauler to meptlest and transport their waste.Therefore,in order to <br /> amount are required 1n/law to u5e a licensed Aspardous wa <br /> psnidpate m thin program.You <br /> uu mmerMitasl H alio DepartmentnMto dretteermiine�you elf0�id'llly for nm theright <br /> of this Nogr�am.Than�Itesls or <br /> consun wide the CWMy <br /> 1 Certify the buslnesa that I am repressngnp is a Conditionally Exempt Small Quantity Generator(CESQG)who generates no <br /> mora than 700 kllorams(27 gallons or 220 pounds)of hazardous waste Per month based on an annual average and 1,the <br /> represersative of the CESQG,untlensMrM the maximum quantity of waste accepted at the time for disposal is 27 gallons or 220 <br /> pounds nand any disposal casts incurred shag be the reaponsfhllaty of the CESQG to pay at the fine of disposal. <br /> Signature <br /> 9/24/2009 2:53 <br /> DO NOT WRITE BELOW THIS LINE <br /> INVENTORY <br /> (Ta ae ca"w"by wiedlon Persson") <br /> Item AIMai am bice unit Tow <br /> Fluorescent Bulbs 70 $0'70 IDs 700 <br /> Sutltotal Rea' $ <br /> Processing Fes $ 20,00 <br /> Total $ 27 00 <br />