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04130!2010 12: 25 2094685672 CLEAN HARBORS PAGE 02/02 <br /> �Harbb�o <br /> NUt90111111EMTAL SERVICES- <br /> ,San Joaquin Co.HHW <br /> 7850 South R.A,8ridgeford 5t CESQG DATA SHEET&WAIVER <br /> Stockton,CA 95206 <br /> Telephone(209)468-5670 JOB6.128208 <br /> F2x'(21)9)468'5672 SA000046 <br /> Bu®iness InfomwWon <br /> Company Nerve. JAHANT FOOO'N'FUEL STOP I Cnm an Re rvsgntative: <br /> street Address: P.O.BOX 2735 E-mail; <br /> l3tatelZip Case: LODE CA 95241 tea:Code&r none a. 209_333-2972 <br /> Buaineae Waiver res Code&Fax Plumber <br /> State and federal hazardous waste laws lkn t the use of this type of waspte cbliection programs to those bu3inesses that <br /> gerierrate less man 100 kuogrems(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_Therefore, <br /> in order to participate in this program,you must sign the following waiver of liability,we reserve the right to review your annual <br /> manifests or consult with the County Environmental liealih Department W determine your e1lglAlugr for use nt this program. <br /> Thank you, <br /> I certify the businoss that 1 am representing is a Conditionally Exempt Small Quantity Generator(CESQG)who genar�tes no <br /> more than 100 kilograms(27 gallons or 221)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 for disporal is 27 arnd 1, a 210 <br /> pounds and any dtsposa{costs incur shall be the responsibl"of the CESQG to pay at the time of disposal. <br /> 4/3012010 1.23 igrtature <br /> DO NOT W F;"TE BELOW THIS LIME <br /> INVENTORY <br /> (To be completed by Lop& iWn perwmm) <br /> Iters <br /> al #I tt*. PF" Unn Tota <br /> aeries(Si le use) $0.813 lbs. $0.80 <br /> Fuel Filters 7_ $1. aa. $2.00 <br /> Subtotalsz.sa <br /> Processing Eel $20.00 ea. 000 <br /> Total $22.80 <br />