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riwftb01'5 D rod <br /> ENVIRONMENTAL SERVICES- <br /> San Joaquin County Permanent HHW Collection Facility 1 <br /> )South R.A Bridgeford Street <br /> Stuckton,CA 95206 <br /> Direct: 209-468-5670 <br /> Fax: 209-468-5672 <br /> CESQG DATA SHEET 8r WAIVER <br /> Business information <br /> Wine Country Station Sandeep <br /> 1111 E Kettleman Ln <br /> Lodi , Ca 95240 209-369-3633 <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 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 /> 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 <br /> 220 pounds and any disposal costs incurred shall be the responsiblitity of the CESQG to pay at the time of disposal. <br /> 6/5/2008 10:35 AM 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 Liquid 43.0 367 1 $5.00 215.00 <br /> Sub total 215.00 <br /> Process fee $20.00 <br /> Total $235.00 <br /> Comments: <br />