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C1eanHar670-­-%- <br /> EUMMOMMENI'M SEE ES` <br /> San.loaqun Co."FiW <br /> 7850 South RA Bridgetord St CESQG DATA SHEET&WAIVER <br /> Stoddort,CA 95206 <br /> Telephone(209)4685670 JOBAF 6J2956891 <br /> Faxc(209)468-5672 SA000048 <br /> Bu>i2s"t•fcr>.alian <br /> Nana: Tuff Boy m Josh <br /> Address 5151 E Aknondwood Dr. Email: <br /> Cods: Manteca Ca 95337 Code&T tk 209-2394361 <br /> Code&Fax Number 209-239-7086 <br /> B�sioKs yllniwr <br /> State and federal hazardous waste Laws knit the use of this type of waste cwlection programs to those businesses that <br /> genenAe less titan 100 ktrams(27 ga8ons or 220 pounds)of hazardous waste per rrronlh_Businesses that generate more <br /> than this amount are required by taw to use a licensed hazardous waste hauler to manliest and transport their waste.Therefore, <br /> to order to pa6cNipate in this program,you must sign the kiHowing wasiver of fiabrTity.We reserve the right to review your annual <br /> manifesfa or consult with the County Envitonmix fal Health Department to delenTMe your eligibility for use of this program. <br /> Thank you. <br /> I certify the business that I am represerrlang is a ConddmaUy Exempt Smaii Quantity Generator(CESQG)who generates no <br /> more than 100 kDorams(27 gallons or 220 pounds)of hazardous waste per month based on an annual average and I,the <br /> representadw of the CESQG,understand the maximum quantity of waste accepted at the time for disposal is 27 gallons or 220 <br /> pounds and any disposal costs incurred shall be the responsiblitity of t3>Q GESQGlop at the time of disposal. <br /> 7/14/2010 1229 Signature <br /> i. <br /> DO NOT PYRITE BELOW IMIS UNE <br /> t MatTORY <br /> (To be cunpleled by cokcbon personnel) <br /> R@i1[i 0/bsJ CAi Prim lhd Total <br /> fuomsrent Lamps 19 $0.7 $13.30 <br /> Copy Machine <br /> Subtota $13.30 <br /> Processing Fee $20.00 ea_ <br /> Tota $33.30 <br />