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CleanHgEor2� <br /> IELY lNOt69tMU <br /> San Joaquin Co.HHYV <br /> 7650 South R.A.Brdgeford St CESQG DATA SHEET&r WAIVER <br /> Stockton, CA 95206 <br /> Telephone(209)46&-5670 J0B#: 6J2246338 <br /> Fax:(209)468-5672 <br /> Susirvess information <br /> Company Name: Amber Land composite Company Representative_ Yee Tann avaron <br /> Street address: 3632 Duck Creek Drive Building F E-mail: veep - lnsitpr <br /> CitydstateMp Code: Stockton,Ca 95215 Area Code&Telephone M. 209-460-1600 <br /> Area Code&Fax Number 209-460-1611 <br /> Business,Waiver <br /> State and federal hazardous waste laws limit the use of this type of waste collection programs to those businesses that generate <br /> less than 100 kilgrams(27 gallons or 220 pounds)of hazardous waste per month.Businesses that generate more than this <br /> amount are required by law to use a licensed hazardous waste hauler to manifest and transport their waste.Therefore,in order to <br /> participate in this program,you must sign the folloAing wasiver of liability.We reserve the right to review your annual manifests or <br /> consult with the County Environmental Health Department to determine your eligibility for use of this program_ 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 kilorams(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 27 gallons or 220 <br /> pounds and any disposal costs incurred shall be the responsiblfiity of the CESQG to pay at the time of disposal. <br /> Date: 31271200=3 -- <br /> DO NOT WRITE BELOW THIS EINE <br /> INVENTORY <br /> (To be completed by coYlectian personnel) <br /> Itern Total Feet #1 ibs.1 Gal Pnce Unit Total <br /> flammable solids(paint) 0 20 $1.60Ibs. $ 32.00 <br /> Paint related Materials 0 5 $5.30 $ 26.50 <br /> 0 0 MA #NIA $ - <br /> 0 0 #N/A #NIA $ <br /> 0 0 #NIA #NIA $ - <br /> 0 v #t�,UA 41\1I,4 <br /> 0 0 #NIA #NIA $ - <br /> 0 0 #NIA #N/A $ <br /> 0 0 #NIA #N/A $ <br /> 0 0 #N/A #NIA $ - <br /> 0 0 #N/A #NIA $ <br /> 0 0 #N/A #NIA $ <br /> 0 0 #NIA #NIA $ <br /> Subtotal $ 5850 <br /> Processing Fee $ 23.00 ea. $ - <br /> Total $ 58.50 <br /> Processing fee already paid <br />