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IeanHa or <br /> ppEIIYIt�10M TI Mo <br /> �,io9Qum'L�o'�li wI TI"W I0y`{ <br /> 7650 South R.A. Bddgeford St CESQG oATA SHEET$WAIVER <br /> Stockton,CA 95206 <br /> Telephone(209)4665670 JOBW 6J2481336 <br /> Fax(209)468.6672 SA000046 <br /> BwiMse Irdbrr 90on <br /> 1C.pany Nemo: Mecca Equipment Can '— <br /> stMetndd-ss 7030 C E Dixon E-mail: <br /> 1cwmbxtPrzocsde Stockton,Ca 95206 res codex r one t 209.989.8790 <br /> lues Code x Pax Number <br /> Business Wafter <br /> State amt federal hazardous waste onus limit the use of this type of waste collection programs to those buslnesses that generate <br /> less than 100 ktgraths(27 gallons or 220 pounds)of hazardous waste per mom#.Businesses that generate Moro than this <br /> amount are roWifed by law to use a tkensed hazardous waste hauler to manifest and transport their waste.Therefore,in order to <br /> partic"m In this program,you roust sign the foiiowkhg wasieer of gaWIItY.uye reserve the fight to review your annual manftm or <br /> consult with the County Envlmnmemal Health Deperhtmnt to damgmne your eiigiblitty for use of this program. Thank you. <br /> I GerM the business that I am representing Is a Conditionally Exempt Small Quamity Generator(CESQG)Who g@MMMs no <br /> mora than 1011 knorams(27 gallons or=pounds)of hazaruoua Waste per month based on an annual average and[.the <br /> representative of the CESQG.understand the maximum quantity of waste accepted at"time for dlsposo is 27 gallons or 220 <br /> pounds and any diapoasl costs Incurred shell be the resporreimifity of rho CESQG to pay at the time of disposal. <br /> Signature <br /> 9/24/2009 2-53 <br /> DO NOT WRITE BELOW THIS LINE <br /> INVEWORY <br /> (To oe mmplOW M cOWIGn persenner) <br /> Rem a r Ibe.1 Gal Pda+ unit Teel <br /> E-Waste 1 s <br /> Monitors 2 <br /> Printers 2 <br /> Towers 4 <br /> Keyboard t <br /> Subtotal $ <br /> Procaming Fee <br /> Total 0 <br />