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CleanHarO7ors <br /> ENVIRONMENTAL SERVICES* <br /> San Joaquin County Permanent HHW Collection Facility <br /> 7850 South R. A Bridgeford Street <br /> Stockton, CA 95206 <br /> Direct: 209468-5670 <br /> Fax: 209-468-5672 <br /> CESQG DATA SHEET 8r WAIVER _ <br /> Business Information <br /> City Of Lodi ( Public Works) John <br /> 221 W Pine St. <br /> Lodi Ca 95241 209-333-6800 Ext:2691 <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 kilgrams(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. <br /> Therefore,in order to participate in this program, you must sign the following wasiver of liability.We reserve the right to review <br /> your annual manifests or consult with the County Environmental Health Department to determine your eligibility for use of this <br /> 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 I,the <br /> representative of the CESQG, understand the maximum quantity of waste accepted at the time fo disposal is 27 gallons or 220 <br /> pounds and any disposal costs incurred shall be the responsiblitity of the CESQG to pay at the time of disposal. <br /> 10/16/2008 1:00 PIA Signature <br /> DO NOT WRITE BELOW THIS LINE <br /> INVENTORY <br /> (To be completed by collection personnel) <br /> Item Gallons Pounds #of Cont. Price Total <br /> Fluorescent Lamps 4 FT 853 2206 0.70 597.10 <br /> Compact Lamps 50 100 1.50 75.00 <br /> Metal Halide 236 592 3.50 826.00 <br /> High Pressure Sodium 527 2182 1.50 790.50 <br /> Mercury Vapor Bulbs 6 19 3.50 21.00 <br /> NON-PCB Ballast 51 17 0.70 35.70 <br /> NON-PCB Ballast(Electric) 144 48 0.70 100.80 <br /> PCB Ballast 60 20 0.80 48.00 <br /> Fluorescent Lams 8 FT 25 20 0.70 17.50 <br /> Sub total 2,511.60 <br /> Process fee $20.00 <br /> Total $2,531.60 <br />