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Sf,,Ci z3outh RA. Bridgeforoi 6! CESQG DATA SHEET &WAIVER <br /> —A 95,2013 <br /> �'eleMlne. JCFWZ6,1261153b <br /> Tim <br /> 221 NXilson Way ~rnafl <br /> f Stockton Ce.9520S 209-465-0281 <br /> "We and federalIarate <br /> hazardous Waste laws;arrit ane Use of this type of waste eoBection program to those lo�smesses dle�t#� <br /> 6.:s titan:tni KilganIS Si ML—ps or 24-ipouno5,'ottiazaicious waste per monn.=menses mat generaze-no's Mao ergs <br /> nwit art Tectuired by InNy to use e tee,ised itazardo caste h: lw to jmni;qst ajjcjtTansp,,ttbek v <br /> astej� <br /> to pirtitip&L-;n this program,you mustsign the fratlemrg xasiver oflialitty-WeveseNethe rigkd to review Your annualr­antfests <br /> or-ortwjk with the County Erwtronrraantai Hiookh Department to determine Your eliqlNitY Far use Of this 90cltarr- Thar 10;J. <br /> than loo irgorarre 07 gaikr,3 Or 220 poNnds)of hazardous waste pet n-Dritin based On an annual average end I the <br /> epre"ntati,,e of he CrSQ"'Understand the maximum"ntP.y of waste accepted at the lima for c5sposai!s 2- gee =or UO <br /> oc:".tim and any tliaposai costs incurred shall be the re3ponsiblaity of the CMG to pay at the time if dso�.,A! <br /> nature <br /> Q2.1-201 101.4., r9 i <br /> 00 NOT WRITE SELOW THIS LINE <br /> litIVENTORY <br /> itpirl 7,c <br /> 6npz, o.-itmi tS x 65 dmmtnefali i oxio <br /> mply:cvtamers ;2 X 3C gailon) i 3 GO ea. <br /> lEmpty Containers C X 5 gp7cnl) '!C.Ufj a <br /> _T <br /> T_ <br /> I <br /> Subtotalf."C <br /> IPessing Fee $20.001 ea. $20 1U.U. <br /> Tota <br /> S'TC 00 <br />