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FROM PREMIER FINISHING PHONE N0. : 2099034050 Jan. 14 2003 12:38PM P3 <br /> CESQG DATA SHREJk& WAIVER <br /> Business Information <br /> Company Name(please print) Company Representative(print your name) <br /> Street Address <br /> T <br /> City/State/Zip Code CATelephone Number <br /> 6 C- 411 <br /> Business Waiver <br /> State and federal hazardous waste laws limit the use of this type of waste collection programs to those businesses that <br /> generate less than 100 kilograms (27 gallons or 220 pounds) of hazardous waste per month. Businesses that generate <br /> more than this aM01jr1t are required by law to use a licensed hazardous waste hauler to manifest and transport their waste. <br /> Thcroforc, in order to participate in this program,you must sign the following waiver of liability. We reserve the right to <br /> review your annual manifests or consult with the County Environmental Health Department to determine your eligibility <br /> for use of this program. Thank you, <br /> I certify the business that I am representing generates no more thajo 100 kilograms(21 <br /> gallons or 220 pounds)of hazardous waste per month based on an annual.average. <br /> Datc Time Signature ; <br /> DO NOT WRITE BELOW THIS LINE <br /> INVENTORY <br /> (To be completed by collection personnel) <br /> Item Price #of Cont. Gallons Pounds Total <br /> �ah"Aeglc7 Zez j�vA <br /> ti <br /> Total <br /> Is 0.2, <br /> .0— <br /> cornments' <br />