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ENVIRONMENTAL SERVICES' <br /> San Joaquin Co.HHW <br /> 7850 South R.A. Bridgeford St CESQG DATA SHEET&WAIVER <br /> Stockton,CA 95206 <br /> Telephone(209)466-5670 JOB#: 6.12820636 <br /> Fax:(209)468-5672 SA000046 <br /> Business Information <br /> Company Name_ Stockton gaff and country club 6mpanV ftepmseritafiueJim alwine <br /> Street Adilmss, 3800 w country club blvd E-mail: <br /> city/stateop Code stockton,ca 952114 rea Code a Telephone W. 209462-6734 <br /> km Code d Fex Number <br /> Business Walver <br /> State and federal hazardous waste laws limit the use of this type of waste collection programs to those businesses that <br /> generate 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 few 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 waiver 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 CESOG to pay at the time of disposal. <br /> 8/20/2010 Signature <br /> DO NOT WRITE BELOW THIS LINE <br /> INVENTORY <br /> (To be completed by collection personnel) <br /> Item #I IbsJ Gal Rica Unit Total <br /> Empty drums 110.001per $6. $60.00 <br /> Flammable liquid 65 .30/ al $40.52 <br /> Subtotal $100.52 <br /> Processin Fee $20A0 ea. <br /> Total $120.52 <br />