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IM! arb <br /> METAL><IE'RlICm <br /> San Joaquin Co.HHW <br /> 7950 South R.A.Midge tord SI CESQG DATA SHEET&WAIVER <br /> Stockton,CA 95206 <br /> Telephone(209)188-5670 JOB#: 8J227949S <br /> Fmc(209)199-5672 <br /> ewlnws hrlaehWan <br /> Com N(aw: ToW Shall R ,les$i h <br /> Swat Address 420 W.Nsttlemen Lane E-mail; <br /> Coos Lodi,CA 95240 Area Cade d Te a: 209499-2790 <br /> Arae Code A Fa Number <br /> ahulrnsa ylelrer <br /> State end federal h9zwdou3 waste laws Ikea the use of tlNs type of waste cdklt50n programs to these businesses that generate <br /> ieas Men 100 kllgrams(27 gal"or 220 pounds)of hazardous waste per molt.Businesses Mat generate mora Oran Orly <br /> amount are required by law to use a licensee hazardous waste hauler to mar fest and Ransoort emir waste.Therefoi .in order to <br /> participate In this program,you must sign the folloMM Weaker of adbglty.We reser.*the right to review your annual mantFiNls or <br /> consult with the G0U*EmIrOnmemel Heath Oeparrmant to delmmi ns your ellgfbAlty for use of this program. Thank you_ <br /> I coolly the Iwslinss mat 1 am mpres*nsng is a Condlbnely Exempt Small Quantity Generator(CESQG)who ganeralm nc <br /> mom than 100 kildmms(27 gallons or 220 pounds)of hazardous wade per month based on an I average and I,the <br /> mpesem80ve of the CESOG,understand the maearmen quanty of waste accepted at dlap0eal is 27 gallons or 220 <br /> Pounds and adisposal costs Incurred shall be Me responsiMtly of Me of <br /> iry <br /> d spoeal. <br /> Date: 4/23/2009 gnat <br /> DO NOT WRITE BE THIS UNE <br /> l <br /> INVENTORY <br /> / <br /> (To to carrhdlated ly oolnalan pelamnel) � <br /> Rem Told Feef 0/Nef Can prim unit Tale) <br /> Fuel riftm 01 35 $1.00 0&. $ 35.00 <br /> OB Fillers 0 30 $0.00 lbs. $ <br /> 0 0 #WA *MIA $ <br /> 0 0 #NIA #N/A $ - <br /> 0 0 *N/A #N/A $ <br /> 0 0 #N/A #NIA $ <br /> 0 0 #NIA <br /> 0 0 #N/A <br /> 0 0 #NIA <br /> 0 0 #N/A <br /> 0 0 <br /> 0 0 #N/A #N/A $ <br /> 0 0 #N/A #NIA $ <br /> Subtotal $ 35.00 <br /> Proeenirt Fe° $ 20.00 ea. $ 20.00 <br /> TCrtal S -Ano <br />