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rte_a�_Har_bS <br /> �RYiR YFJfiAL SERYtGES' <br /> 7850 South RA Bridgeford SI CESOG DATA SHEET &WAIVER <br /> Stockton,CA 95200 <br /> Telephone(209)4WS670 JOBS: 8J2d87336 <br /> Fax:(209)4695672 SA0oo0as <br /> swinoas j Am otinn <br /> Nano: Nlecca E ui Ment 1COMIMYR <br /> S MM AMMM 7030 C E Dixon E-mail: <br /> G srseera coda: Stockton Ca 95208. Nee Code 9 TaMphonoR 209-983-8790 <br /> Aral Code&FM NYrrlber <br /> StateState and s f deer <br /> afederal hazardous waste taws limb the use of lois type of wade mlleCUon programs to those nudnasses that generate <br /> leen than 100 Migrants(27 gallons or 220 pounds)of hazardous waste per month.Businesses that generate more than this <br /> ammm ate required by taw to use a licensed hazardous waste hauler to manifest aid transport their wasrn.Therefore,in order to <br /> padlom is program. �819n the oblight r annual mrMests or <br /> Participate rtmentdetermia your e1joi� ouse of this programThakyo <br /> I certiy the business that 1 am representing is a Conditionally Exempt Small Qu*nthy Generator(CMG)who generates no <br /> mom than 100 Idlorsme(27 gallons ar 220 potmda)Of hazardous waste per month based on an annual average and 1,the <br /> moresemetw of the CESM understand the matdmum quan ty of waste accepted at the tkne for disposal is 27 gallons or 220 <br /> pounds and any disposal costs incurred shalt be the rosponslblltiy of the CESQG to pay at the time of disposal. <br /> 9/2412009 2:53 Signature <br /> DO NOT WRITE BELOW THIS LINE <br /> INVENTORY <br /> ffo be completed by ctNl("on permnnM) <br /> Item a r roes sal Pna unit TmM <br /> Fluorescent Bulbs 10 $0.70 ibs S 7.00 <br /> Subtotal $ 7.00 <br /> pfeg Fee $ 20.00 ea. $ 20.00 <br /> Total $ 27.00 <br />