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leanHarbo <br />ENVIRONMENTAL SERVICES`° <br />San Joaquin County Permanent HHW Collection Facility <br />7850 South R A Brtdgeford Street <br />Stockton, CA 95206 <br />Direct : 209-488-5670 <br />Fax 209-468-5672 <br />18754 E HWY 26 <br />209-887-1101 <br />CESQG DATA SHEET & WAIVER <br />Bush 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 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 haler to manifest and transport their waste. <br />therefore, in order to participate in this program, you must sign the following wasiver of liability. We reserve the right to review <br />your annual manifests or consult with the County Environmental Health (Department to determine your eligibility for use of this <br />program. Thank you. <br />I certify, the business trial I am representing is a Conditlonaily Lxempt Small Quantity Geneialor (.CESQG) who generates no <br />more than 100 kdorams (27 gallons or 220 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 to disposal is 27 gallon; or 220 <br />pounds and any disposal costs incurred shall be the responsiblihty of rh.a CESQG to pay at the time of disposal. <br />2x12/2009 10.51 A gi nature <br />DO NOT WRITE BELOW THIS LINE <br />INVENTORY <br />(To be completed by cwlloeiion pasonnep <br />lam <br />Fuel Filter <br />56 28 Too 28.00 <br />Sub total <br />28 8.00 <br />Process fee <br />$ 00 <br />Total V <br />- V8.00 , <br />