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• ! <br /> Ievir <br /> ENMROMMEMTAL SERVICES' <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 JOB#: 6J2913671 <br /> Fax:(209)468-5672 SA000046 <br /> Business information <br /> ::ompany Name: Excelente Auto Body&Frame Company Representative. Raul <br /> $kreet Address: 540 N Grant Suite#30 E-mail <br /> �Ry/SWWZipCode: Stockton Ca 95202 rea Code&Telephone a. 209-922-3470 <br /> Ex rea Code&Fax Number <br /> euslneas wateer <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 kilgmms(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 Meir waste.Therefore, <br /> in order to participate in this program,you must sign the following wasiver 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 /> 1 certify the business that I am representing is a Conditionally Exampt 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 responsiblitily,of the CESQG to pay-st the time of disposal. <br /> Signa <br /> 6130/2010 12:42 i w <br /> DO NOT WRITE BELOW THIS LINE <br /> INVENTORY <br /> (To be completed by collection personnel) <br /> Item #!lbs/Gal Pnce Unit Total <br /> Flammable Liquids t0.a 92 $5.3 al $57.36 <br /> #N/ $- <br /> $- <br /> Subtotal $57.36 <br /> ?rocessin Fee $20.00 ea. 20.00 <br /> Total $77.36 <br />