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E11111ROwM1EIRAL 4ERYICEf <br /> San Joaquin Co.HHW <br /> 7650 South RA Bndgeford St CESQG DATA SHEET&WAIVER <br /> Stockton,CA 95206 <br /> Telephone(209)468-5670 JOB#: 6.12820636 <br /> Fax:(209)468-5672 SA000046 <br /> &rairracs krbmudion <br /> Cornparry Name. A-Transrniss1ons kompany Re reeentative_ Eric Goodman <br /> nddr ss 3732 N.Wilson Way E{nail: <br /> code: Stockton.Ca 95205 rea code s Telephone#: 2094"-0151 <br /> Cade a Fax tAxnber 466-0152 <br /> Buskren lralrer <br /> State and federal hazardous waste laws limit the use of this type of waste collKtkin programs to those businesses that <br /> generate less than 100 kilograms(27 gallons or 220 pormds)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 their waste.Therefore, <br /> in order to participate in this program,you must sign the following wasiver of liability.We reserve the nght 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 /> 1 certify the business that 1 am representing is a Conditionally Exempt Snail Quantity Generator(CESQG)who generates no <br /> more than 100 kilograms(27 gallons or 220 ponds)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 for disposal is 27 gallons or 220 <br /> pounds and any disposal costs incurred shall be the reeports0tility of the CESQG to pay at the time of disposal. <br /> ignaturs C I <br /> DO NOT WRITE BELOW THIS LINE <br /> INVENTORY <br /> (To Oe competed by collection peisomrel) <br /> Item •;ani Gal PnM Una Total <br /> Fluorescent Lamps $0.7 $0.70 <br /> ORION <br /> Subtotal $070 <br /> Fee $20.00 ea. 0.00 <br /> Total $20.70 <br />