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L rbor <br /> ENVIRONMENTAL <br /> San SERVICES- <br /> JcjagLmn County permanent HHW Collection F <br /> 7850 South R.A Brâ–ºdgeford Street acuity <br /> Stockton. CA 85206 <br /> Direct: 209- -5670 <br /> Fax: 209-468-5672 <br /> Business information DATA SHEET & WAIVER <br /> Joe Dangtran <br /> 717 W Eigth St <br /> Stockton Ca 95206 <br /> 408-666-0009 <br /> Business Waiver <br /> State and federal hazardous waste laws limit the use of this type of waste collection r <br /> generate less than 100 kilgrams(27 gallons or 220ous programs to those businesses that <br /> than this amount are required by law to use a licensed pounds) <br /> waste hauler t waste manifest and transport themonth. Businesses that ir waste, more <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 1,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 10:10 AM Signature i <br /> DO NOT WRITE BELOW THIS LI <br /> INVENTORY <br /> (To be completed by collection personnel) <br /> Item Gallons Pounds of Cont. Price Total <br /> Paint Related Material 40 10 NIC 0.00 <br /> Batteries (HH) 1 N/C <br /> Sub total 0.00 <br /> Process fee Waived - $0.00 <br /> Total: $0.00 <br />