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tiHMICEf' <br /> ow- <br /> DEMO,�- -- <br /> San Joaquin Co.HHW <br /> 7850 South R.A. Bridgeford St CESQG DATA SHEET&WAIVER <br /> Stockton,CA 95206 <br /> Telephone(209)4585670 JOB#: 6J2913871 <br /> Fax:(209)468-5672 SA000046 <br /> Business ktiwmatlon <br /> Name: SRJ m n Representative: BRENT BEERS <br /> Street Address: 6®01 Longe Street <br /> Com: Stockton Ca 95206 rea Code&7eleptione M: 209-982.5482 <br /> rea Code&Fax Number <br /> Businsas Waive+ <br /> State and federal hazardous waste laws limit the use of this type of waste cone don 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 Iheir waste.Therefore, <br /> In order to participate In ibis program,you must sign the following wasiver of Ilabl f 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 /> I certify the business that I am representing is a Conditionally Exempt Small Quantity Generator(CESQG)who generates no <br /> more than 100 kllorams(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 quan"of waste accepted at the time for disposal is 27 gallons or 220 <br /> pounds and any disposal costs incurred shall be the responsiblttity of the CESQG to pay at the time of disposal. <br /> Signature I <br /> 6/23/2010 11:42 <br /> DO NOT WRITE BELOW THIS LINE <br /> INVENTORY <br /> (To be completed by collection personnel) <br /> Item A I Ibsl Get Price Unit Total <br /> Waste Oil 20 $0-DC lbs. $- <br /> cid(inorganic) 46 $2.1C tbs. $96.60 <br /> Latex Paint 0.9 8 $5. al. $4.99 <br /> Empty Containers 3 x 5 al 1 $10. a. $10.00 <br /> Subtotal $111.59 <br /> Proc"3ing Fee $20.00 ea. <br /> Total $131.59 <br /> IVEL <br /> AUG 2 5 2015 <br /> _NUIRONMENTAI <br /> ,rrnrr�_r nrrynr-)Tl4r7k, <br />