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CleanHar <br /> ENVIRONMENTAL SERVICES., <br /> San Joaquin County Permanent HHW Collection Facility <br /> 7850 South R.A Bridgeford Street <br /> Stockton. CA 95206 <br /> Direct 209468-5670 <br /> Fax: 209-468-5672 <br /> DATA SHEET & WAIVER <br /> Business Information <br /> Shell 1-5 Joe Dangtran <br /> 717 W Eigth St <br /> Stockton Ca 95206 408-666-0009 <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 220 <br /> pounds and any disposal costs incurred shall be the responsiblitity of the CESQG to pay at the time of disposal <br /> r <br /> 12/5/2008 10:10 AM Signature <br /> 1�171�4n 14 el� <br /> DO NOT WRITE BELOW THIS LINE 'f <br /> tNVENTORy <br /> (To be completed by collection personnel) <br /> Item Gallons Pounds #of Cont. Price Total <br /> Fuel Filters 14 14 1.00 14.00 <br /> Flammable Solid (hose) 70 4 1.60 112.00 <br /> Sub total <br /> 126.00 <br /> Process fee - $20.00 <br /> Total <br /> ' $146.00 <br />