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WIN <br /> San Joaquin Co.HHW <br /> 7850 South R.A Brid"IlO d St CESGG DATA SHEET 8r WAIVER <br /> Stockton.CA 95206 JOB#. SJ2913671 <br /> Telephone(209)468-.5670 SAD00046 <br /> Fox(209)46&5672 <br /> tiuriness��� <br /> m n R byc. BRENT BEERS <br /> Narne: SRI <br /> Stvet Address 6801 Longo Street <br /> Ccee. Stockton Ca 85208 Code&T hone#: 209-982-5482 <br /> Code&Fax Number <br /> Bu%hmss WBKW <br /> of waste Ir?'clfon programs to itrose businesses that <br /> State and federal hazardous waste laws limit the use of this type P�mors Businesses that generate more <br /> generate lase gran I oo kilgrams(27 gallons or 220 pounds)of hazardous transportnifest and <br /> than this amnt ouare required try Carr to use a licensed hazardous waste he to We reserve the right to review Your annual <br /> In order m participate in this Program,YOU must s gn[he following washer of this program <br /> itabfltgv. <br /> manftsts or consult with the County Environmental Health Department to ermine your eligibility far use . <br /> Thank you. <br /> I certify the business that 1 am representing is a Conditionally Exempt Smal Quantity Generator(CESGG)who ge�reti6no <br /> more than 100 Worarns(27 gallons or 220 pounds)of hazardous wastemonth et the time nfor d�rsposay t��gallons or 220 <br /> representative of the CESGG,understand the maximum quantity of waste at the time of disposal. <br /> pounds and any disposal costs incurred shall be the responsiblititY of the G to pay <br /> Signature ' <br /> 6/23/2010 11.42 <br /> DO NOT WRITE BELOW T IS LINE <br /> IMVENTORY <br /> (To be completed by comdion noel) <br /> K tbsl Gel Price Unit Total <br /> Rem �. <br /> 20 $0. Ibs. <br /> Waste OilE <br /> 46 $2.1 Ibs. $96.60 <br /> Acid(Inor anis <br /> Latex Paint 0. 8 $5. al. 00 <br /> Em Containers 3 x 5 gal) 1 $10. a. $10.00 <br /> Subtotal $1 t 1.5s <br /> �rocessing Fee rN <br /> $. <br /> Tota' <br /> MAY 0 7 2014 <br /> ENVIRONMCNTAL HEALTH <br /> DEPARTMENT <br />