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r <br />San Joaquin Co. MHW ER <br />7850 South RA Bridgefard St CESQGDATA SHEET <br />Stockton, CA 95206 JOBM GJ2481336 <br />Telephone (209) 468-5670 <br />Fax:(209) 468-5672 <br />om an Name: 8 & C Painting <br />107 Val Dervin <br />Stockton Ca 95215 <br />CAL000251953 <br />sus <br />State and us waste laws limit the use of this type of waste collection programs to those businesses t <br />generate less than 100 ktigrams (27 gallons or 220 pounds) of hazardous waste per month. Businesses that generate more <br />than this amount are requiredthis program, youust signlaw to use a the he following wasiver of liability. We reserve thd hazardous waste hauler to manifest and transport <br />fight to their <br />eview your nnual <br />in order to participate <br />manifests or consult with the County Environmental Health Department to determine your eligibility for use of this program. <br />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, ther 220represent~ of the CESQG, understand the maximum quantity of waste accepted at the time for dls pry <br />pounds and any disposal costs incurred shall be the responsibiility of the CESQG to pay at the f dis !. <br />—: <br />r♦ <br />INVENTORY <br />(To be completed by coilection personnel) <br />