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04/30x'2010 12:36 2094635672 CLEAN HARBORS PAGE 01/01 <br /> ,Nrb <br /> 61 VIROMMEKTAL SERVICES' <br /> San Joaquin Co.HHW <br /> 78550 South R.A_Bridgafvrd St CESGG DATA SHEET&WAIVER <br /> Stockton,CA 95206 <br /> Telephone(209)458-5670 JOB#: SJ2820636 <br /> Fax:(209)4685672 <br /> swim information SACOG(346 <br /> Mpany dame: JAHANT FOOD wFUEL STOP I Com Raprweentative <br /> rc:o jresa: P.Q.BOX 2735 E-mail <br /> wStatarLq,Code: LODE CA 95241 ro9 Coact&Tele none ft 209-333-2972 <br /> Bucinets Wratwr <br /> rea Code&Fax Number <br /> State and f®rleral hazardous wast®Idws Nmft the Use of this type of wane co9ection programs to those businesses that <br /> geAerate less than 100 kliograms(27 gait rm 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 right td review your annual <br /> manifests or consult with the County Environmental Health Department to determine your eligibility for use of ictus program, <br /> Thank you, <br /> I certify the business that I am reprewliing is a Cor ditionaly Exempt Small Quantity Generator(CESgG)who generates no <br /> more than 100 kilograms(27 galtons or 220 pounds)of hazardous waste per month based On an annual average and 1,the <br /> representative of the CESOG,understand the maximum quantity of waste accepted at the bore for dispoael is 27 gallons w 220 <br /> Pounds and any disposal costs incunert shall be the resptmsibi tity of the CESQG to pay at the time of disposal. <br /> 4/30/2010 1.23 ignature <br /> DO NOT WRITE BELOW THIS LINE <br /> INVENTORY <br /> fro Ge Completed by cooed o perwnrn ) <br /> Item <br /> gat 9/rbs. Pace tal Unit To <br /> tteties Single use <br /> Fuel Filters $0,80 <br /> 2 $1.0 a. <br /> $2,00 <br /> Subtotal $2.80 <br /> Processing Fee $20-00 ea_ <br /> Tota $22.80 <br />