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QeanHarborS <br /> ENVIRONMENTAL SERVICES' <br /> San Joaquin County Permanent HHW Collection Facility <br /> 7850 South R.A BrWWford Street <br /> Stockton,CA 95206 <br /> Direct: 209468.5670 <br /> Fax 2094611-5672 t <br /> is <br /> Business Information CESQG DATA SHEET& WAIVER <br /> Joshua's Auto Electric Parts Carlos <br /> 738E Charter Way <br /> Stockton Ca, 95206 209-948-24155 <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 kiigrams(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 hauler to manifest and transport their waste. <br /> Therefore, in order to participate in this program, you must sign the following wasiver of liability. We re <br /> your right to review <br /> th <br /> your annual manifests or consult with the County Environmental Health Department to determine your serveeligibit h for use of this <br /> program. Thank you. <br /> I certify the business that I am representing is a Conditionally Exempt Small Quantity Generator(CESQG)who generates no <br /> more than 100 kilorams(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 fo disposal is 27 gallons or 220 <br /> pounds and any disposal costs incurred shall be the responsiblitity,of the CESQG to pay at the time of disposal. <br /> 7/9/2008 3'00 PM Signatu <br /> DO NOT WRITE BELOW THIS LINE <br /> INVENTORY <br /> (To be completed by collection personnel) <br /> Item Gallons Pounds i of Cont. Price Total <br /> Empty Containers 13 10.00 130.00 <br /> Sub total 130.00 <br /> Process fee $20.00 <br /> Total $150.00 <br />