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aeanoarba + • <br /> ENVIRONMENTAL SERVICES' <br /> San Joaquin County Permanent HHW collection Facility <br /> 7850 South R.A Bridgeford Street <br /> Stockton, CA 95206 <br /> Direct: 209-468-5670 <br /> Fax: 209-468-5672 <br /> Business Information CESQG DATA SHEET & WAIVER <br /> Arch Arco AM/PM Sandeep --� <br /> 4855 South State Route 99 <br /> Stockton Ca. 95215 209-948-2438 <br /> Business Walder <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 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 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 /> 1 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 /> 12/5/2008 3:44 PM Signature <br /> DO NOT WRITE BELOW THIS LINE <br /> INVENTORY <br /> (To be completed by collection personnel) <br /> Item Gallons Pounds #of Cont. Price Total <br /> Flammable Solid(3 Noozle &2 hose) 40 5 1.60 64.00 <br /> Flammable Liquid(Oiiy water 37.3 317 1 5.30 197.66 <br /> Light bulb 4 N/C 0.00 <br /> Sub total 261.66 <br /> Process fee $20.00 <br /> Total $281.66 <br />