Laserfiche WebLink
RECEHED <br /> 4 Gu li <br /> .. 'ENVIRONMENT HEALTH <br /> rjiwKxp r PERMIT/SERVICES <br /> EIMMMEMEMAL SAMMI S' <br /> San Joaquin Go.HHVY <br /> 7850 South R-A.Sridgeford St CESQG DATA SHEET$WAIVER <br /> Stockton,CA 95246 <br /> Telephone(249)468-5670 Jok. 6J27708 1 <br /> Code: 5tncirkOq Ca 52fl6 es Code h T #- 209-$47-7'.524 <br /> Code fax Mumbo <br /> Busimms Waivef <br /> Sime and fetterai hazardous waste taws knit the use of thas type of waste coat an prograrns to those businesses that <br /> generate less than 1 t30 kilograms(27,ga#vns or 220 pounds)v(hazardcws waste per month_Businesses that generate mom <br /> than itm affront are required by larw to use a Scensed hazardous waste hauler to rank—A and transport their waste.Therefore, <br /> in order to paatinipate in this piogrrm,you must sign P:a tAow9 waiver of liability.We reserve the right to review your annual <br /> mantfesZ or mnsut!with Ne-County Emmonmentai 1 W-altr,Department to determine Year ebgbft for use of this program. <br /> Than*you. <br /> I certify the busiwess that l am representing is a CorxWxxiaiy Exeao Sara#Quantity Generator(CESOG)who generates no <br /> mom than 1010 kitogm ms(27 gaPom or?20 pounds)of hazwdaus waste per month teased on an annual average and t,the <br /> representative of the CESOG,urderstand the maxirwrn quantity of waste aooepted at the_time for disposal is 27 gallons or 220 <br /> pounds and any disposal casts incurred sha6t be the nsspvnsibty of the CESt3G to pay the time of dlspdsal. <br /> 3,-26/2010 2.56 Suture <br /> DO NOT YYR3TE BELOW THIS LME <br /> INVENTORY <br /> tTo be oompldled by 0060dion Perworml) <br /> Item A f t m.i Gal PrKM Unit Total <br /> Batteries(&29( use) 48 $0. $38.40 <br /> Batteries(Single use) 300 $4. $244.00 <br /> Subtotal $278.40 <br /> Processing Fee $20.00 ea. S20.fl0 <br /> Tota $29$.40 <br />