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IeanHarbo <br /> ERVIRGNNWJ TAI SERVICES" <br /> San Joaquin Co.HH W <br /> 7850 South R.A. Bridgeford St CESQG DATA SHEET& WAIVER <br /> Stockton,CA 95206 <br /> Telephone 209 468.5670 JOB#: 6'2859220 <br /> ICkLlSwefZip Code: Stockton Ca 95205 ma Code&TeJelphone#. 209-547-7524 <br /> Businebs Warver 6Code&Fax Number <br /> State and federal hazardous waste laws limit the use of this type of waste collection programs to those businesses that <br /> generale less than 100 kilograms(27 gallons or 220 pounds)of hazardous waste per month.Businesses that generate more <br /> than this amount are required by law to use a licensed hazardous waste hauler to manifest and transport their waste.Therefore, <br /> in order to participate in this program,you must sign the following welver of liability.We reserve the right to review your annual <br /> manifests or consult with the County Environmental Health Department to determine your eligibility for use of this program. <br /> Thank you. <br /> I certify the business that I am representing is a Conditionally Exempt Small Quantity Generator(CESQ(3)who generates no <br /> more than 100 kilograms(27 gallons or 220 pounds)of hazardous waste per month based on an annual average and I,the <br /> representative of the CESQG,understand the maximum quantity of waste accepted at the time for disposal is 27 gallons or 220 <br /> pounds and any disposal costs incurred shall be the responsibility of the CESQG to pay at the time oj)disposal. _ <br /> 5/13/2010 2:56 Signature <br /> DO NOT WRITE BELOW THIS LINE <br /> INVENTORY <br /> (To be completed by collectron personnel) <br /> Item #/lbs./Gal Price Unit Total <br /> Batteries(Single use) 43 $0.8 Itis. $34.40 <br /> Batteries Sin le use 72 $0.8C lbs. $57.60 <br /> Subtotal $32.00 <br /> Processin Fee $20.00 ea. $20.00 <br /> Total $112.00 <br />