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ENVfRBNNENTAL SENYMES' <br /> San Joaquin Co.HHW <br /> 7850 South R.A.Bridgeford St CESQG DATA SHEET&WAIVER <br /> Stockton,CA 95206 <br /> Telephone(209)468-5670 JOBII: 6J2770981 <br /> Fax:(209)468-5672 SA000046 <br /> Business Information <br /> oro an Name: San Joaquin Co Park and Rec lCornpanyRepresentative Charlie <br /> Address: 4520 N 8 Mile Rd E-mail: <br /> kityBta1eZ code: Stockton Ca 95209 res Cone I Telephone#: 209-953-8802 <br /> CAH31000318 krea Code 8 Fax Number 209331-2012 <br /> Business Waiver <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 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 waiver of liability.We reserve the fight 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(CESQG)who generates no <br /> more than 100 kilograms(27 gallons or 220 pounds)of hazardous waste per month based on an annual average and 1,the <br /> representative of the CESQG,understand the maximum quantity of waste accepted at the time for disposal is 7 gallons or 220 <br /> pounds and any disposal Costs incurred shall be the responsibility o e C QG to pay at 'me of dispo <br /> 3/25/2010 9:38 IS gn 1 <br /> DO NOT WRITE BELOW THIS LINE VOL <br /> INVENTORY <br /> (To be wmpkNed by oorecbon Personnel) <br /> Item #/PUI Gal Price Unit TOW <br /> Flammable Liquid 32.0 272 $5 30 gat $169.60 <br /> Subtotal $169.60 <br /> Processin Fee $20.00 ea. $20.00 <br /> Tota $189.60 <br />