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02/10/2010 15:10 DELL1125 2093342654 #001 Page 05/06 <br /> LleanHar!o <br /> EINMInN(03144s�ltrnit lEs- <br /> San Joaquin Co.HHW <br /> 7850 South RABridgeford St CESQG DATA SHEET&WAIVER <br /> MENTAL <br /> Stockton,CA 95206 <br /> Telephone(209)468.5670 <br /> Fa)c(209)468.5672 Jow. SJM67W <br /> 8"In..e information SA000046 <br /> Name, The Tuno-up Srv <br /> R nlebve Brian <br /> Svenet aeer..e: 1 West Lod(Avo <br /> E-mail, <br /> r5:et./Zl Codi Lod},4 95240 raa Cod.a ran• r 209434-2654 <br /> Business Wslver ro.Coos a>:ax Numbs <br /> State and federal hazardous waste laws limit the use of this type of waste Cotler�on programs to nose business,,that <br /> generate loss than a re kilograms(27'gauonb or ZZO pounds)of hazdrdW$wast,Per month.Businesses mat generate more <br /> Man tfnis amount are required by tow to use a licensed hazardous waste haula to Per m ont and transport their waste.Therefore, <br /> in order to Daftidpate in this program,you must sign the the County fallowing waiver of flability.Wo reserve ft right tD review your annual <br /> manifests or OonSuit nli!}n ty EnvirOrtmental Health Department to dotemnino your ollglbillty for use of this program. <br /> Thank you. <br /> I Certrty the business that I am representing is a Conditionally Exempt Small Quantity Generator(CESOG)who generates no <br /> more than too kilograms(27 gallons or 220 pounds)of hazardous waste gel month Based on an annual average and I.the <br /> reprewtatiVA Of the CESQG,understand the mardmum Quantity of waste a <br /> pounds and any disposal costs lrtccepted at the lime for disposal is 27 gallons or 22Incurred shall the responslbiltty of Una CESoG to pay at the time of disposal. <br /> 2/10/2010 ��: Signature <br /> DO NOT WRITE BELOW THIS LINE <br /> INVENTORY <br /> (To be completed by Cod-wri P.rson"al) <br /> Item <br /> */ <br /> Fluon,acent m s <br /> ft./Gal Priors Unit 70101 <br /> Le <br /> anic Base <br /> 30.7 Itis 50.70 <br /> 7 $2•1 lbs $1d_70 <br /> Subtotal S15 <br /> rocsssin Fee 520.00 ea. <br /> Tota $35.40 <br />