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�-an.Joaquin^lounty Permanent HHWF C 0IIRr<ti.n Facil ty <br /> Th u South R.A.UndgefA Street <br /> `=tockton,CA 952015 <br /> Direct: 209.488-5870 <br /> Fax: 209-468-N672 <br /> CES G DATA SHEET &WAP)ER <br /> 6/1901690 Information <br /> Excetente Auto Bo 8,8 Frame __ -- ---- — __.--------------_—__—.' <br /> 540 N. Grana St Ste 30 <br /> {Stockton 95202 09-298-5804 — <br /> I � <br /> 8119111see WNW <br /> State and federal hazardous waste laws fir at the use of this type of reaste collection programs to those businesses that <br /> generate less than 100 kilgrams t27 gallons or 220 pounds)of hazardous waste per month.Businesses that generate <br /> more than this amount are required by law to use a licensed hazardous waste hauler to manifest and transport their <br /> waste.Therefore,in order to participate in this program,you rre.ist sign the following wasfver of liability.Nk resen e the <br /> right to review your annual manifests or consult with the County Environmental Health r=eparbtent to determine,;our <br /> eligibility for use of this program. Thank you. <br /> I certify the business that I am representing is a ConddionalPi Exempt Small Quantity'Generator(CE=+QG)vaho <br /> generates no more than 100 kilorarns(27 gallons or 220 pounds)of hazardous wasre per month based on an annual <br /> average and 1,the representative of the CESQG.understand the maximum quantity 'o ante accepted at the time fe <br /> disposal is 27 gallons or 220 pounds ar,d ar•.y disposal costs incurred shalt be the responsiblitity of the C;ESOG to pay at <br /> the tine of disposal. <br /> 41912008 12:40 F ignat <br /> DO NOT WRITE BELOW THIS LINE <br /> INVENTORY <br /> (To be Completed by Colleetlon personnety <br /> Item Gallons Raunds 4o Cont. Prce Total <br /> Flammable Liquid --j - T _�-8 1 5.00 /gal 471 <br /> Flammable Solid 1 I 1 1.50!lb1.50 1 , <br /> SLab total _ j i €.4.1 <br /> Fr oeess fee $ZJ.4'•{1l <br />