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02/11/2010 06: 58 2093349903 PAYLESS AUTO REPAIR PAGE 02/03 <br /> EAAMIRaA9WMTA1L SWAVWIO We <br /> San doegldn Co, 14MVI <br /> 7850 South R RrldOeford St CESQG DATA$MEET&WAIVER <br /> Stockton,CA 952061 <br /> Telephone(209)466-6670 JOB#: gJ2728799 <br /> F:ax•i 209)4685672 SA000046 <br /> 8uelnasa Inlerrri"on <br /> Company Name: Pagless n R ntative: Frank Pelko <br /> StmaAddreaa: 26 No Cherokee Ln Butte B E-mail: <br /> /Stete2l Cade Lodi Ca 95240 raa code&Tal hone a, 289.934.3112 <br /> Aron Cate&Fm Number <br /> nualn en Wnlxnr <br /> Stain and fr?dnrol hazemous oasts laws Ilmit the rhea n1'rots type of waatP C011ettlon Progmme,to those pusrnHs ,(lwt <br /> geml.mtc lest than rot)kllogroms(27 gallons or 220 poumfn)of hnzordoua waste per mor" Busirroesea that penerste more <br /> than Ihls amount are required by haw to usn a licensed ha7,ardous waste hauler to manttast snd transport thea waste.Therefore. <br /> In ordor to participate In this program,you must sign the raltowlnq we"r of liability.We reserve Hie right to review your annual <br /> mamirn^.14 or ronstln with the County Env"ri 1er11al Health Depenmem to determime your P.a(tibiaty for use of thle program. <br /> Thank you, <br /> I nortlfy the buslnnas that)am representing Is a Conditionally Exempt Small Quantity Generator(CESQG)who ganeratee no <br /> mora thin 1011 kionmris(27 paeans or 2.20 pounds)or hnxardousmrrrta per month baserl on an annual average and I,the <br /> repmsernlalhre of the rESQG,understand thin,maximum quantity of waste accepted At 016 time for dlgpasal Is 27 gallona or 220 <br /> ponnrls and any disposal coats,Incurred shall be ate responsibility off"CESQG to pay at the time oft laposal. <br /> 2/10/2010 11:02 Slgn»tuna,., a <br /> DO NOT WRITE BELOW TF08 LINE <br /> INVENTORY <br /> (Td wcompwen by oDmw npersonnel) <br /> Item a W /Gal Rice Una Totai <br /> Flammable Solid 47 $1.60 ibs $75.20 <br /> oor swee �. <br /> metal shaving f- <br /> luorescent Lamps 14 $0,70 lbs. $9.80 <br /> Subtotal $85.00 <br /> Processin Fee $20.00 as, <br /> Tota $105.00 <br /> �I <br />