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06/09/2010 14:50 2099293919 KIh1 POTTS PAGE 02/03 <br /> rimHarborlisl <br /> IERVIRIMMEMTAa_SOM7OW <br /> San Joaquin Co.MI-M <br /> 7850 South R.A.Bridgeford St CESQG DATA SWEET&WAIVER <br /> Stockton,CA 95209 <br /> Telephone(209)468-5670 JoB#: 6.112720M <br /> Fax(209)4615-5672 SAOOOOd6 <br /> attsiness lrrlfpMrlettdr* <br /> Company Na". Stloeton auto Disorm""ersa om Fie tatwn: David Pt)ttt3 <br /> $(met Addrej": 3239 S el dorado E-mail: a, t rau o <br /> G rstsrerzi Code: sbockton ca 95208 Area Code s Tare hone 1t: 209-929-3900 <br /> EPA#CAL000039611 Area code a rax Numtterr 209-929.3919 <br /> Buslne"W"Ner <br /> State and ft+denrl hazardous waste laws limit the use of this type of WROO collection programs to those businesses th92 <br /> penerate ler s titan 100 kilgrams(27 Q9IIon%or 220 pouMs)of hazArdous waste pet month.Businesses that generate mort3 <br /> than this amarnt are requlned by law to use a licensed ttaTardeus waste hauler to manifest and transport their waste.Therefore, <br /> in order to participate In this pmgram,you must sign the fteilowing wasiver of llabillty.INA reserve the right to rrvlew your annual <br /> manifests or coneull with the County Environmental Health Department to determiner Your erigibility for use of this pmgrstm. <br /> Thank you. <br /> I Certify the business Mat I am mprasenting is a CondlHonally Exempt Small Quantity Generator(CESQG)who gerterates no <br /> more than 100 kitoratns(27 gallons or 220 pounds)of hazardous waste per month based on an annual average and I,the <br /> representative of tM CESOG.understand the maximum quantity of waste accepted at the tlme for dlapoaal is 27 gallons or 220 <br /> pounds and any dispo8aI costs incurred shAll be the responctbltlity of the CESQG to y at the of dlspoaat. <br /> 1-1 <br /> Sina <br /> Ina Sl9/2010 2:00 <br /> 00 NOT WRrM BELOW THIS LINE <br /> INYFNTORY <br /> (To bo comWered to uulh_--ction Gersanne,r) <br /> Item >R I15c.1 Gal Prtco Ung Total <br /> Flammable fzolid absorbent 60 $1.fi Ib $96.00 <br /> it MOM 10 n/c 1b �- <br /> FluoresWnt tams 1 $0.70 1b $0.70 <br /> Alkaline Batteries 1 $0.80 $0.80 <br /> Subtotal $97.50 <br /> procassing Fee $20,00 ea. <br /> Total x117.50 <br />