Laserfiche WebLink
CleanHarbors <br /> ENVIRONMENTAL SERVICES" <br /> San Joaquin County Permanent HHW Collection Facility <br /> 7850 South R.A Bridgeford Street <br /> Stockton, CA 95206 <br /> Direct: 209-468-5670 <br /> Fax: 209-468-5672 <br /> CESQG DATA SHEET & WAIVER <br /> Business Information <br /> JM MFG <br /> 1051 Sperry Rd <br /> Stockton Ca 95206 209-982-1500 EXT 218 <br /> Business Waiver <br /> State and federal hazardous waste laws limit the use of this type of waste collection programs to those businesses that <br /> generate less than 100 kiigrams(27 gallons or 220 pounds)of hazardous waste per month. Businesses that generate more <br /> than this amount are required by law to use a licensed hazardous waste hauler to manifest and transport their waste. <br /> Therefore, in order to participate in this program, you must sign the following wasiver of liability.We reserve the right to review <br /> your annual manifests or consult with the County Environmental Health Department to determine your eligibility for use of this <br /> program. 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,the <br /> representative of the CESQG, understand the maximum quantity of waste accepted at the time fo disposal is 27 gallons or 220 <br /> pounds and any disposal costs incurred shall be the responsiblitity of the CESQG to pay at the time of disposal. <br /> 5/14/2008 11:30 AM Signature <br /> DO NOT IT ELOW THIS LINE <br /> INVENTORY <br /> (To be completed by collection personnel) <br /> Item Gallons Pounds #of Cont. Price Total <br /> Base (inorganic) 200 13 "'l <br /> .00/ .lb 400.00 <br /> Used Oil 719 /C 0.00 <br /> Empty Containers 120 0 ea. 30.00 <br /> Aerosols 10 13.00/lb 30.00 <br /> Acid (inorganic) 175 3 2.00/ .lb 350.00 <br /> Paint Related Material 17.8 151 5.00/qal 88.82 <br /> 898.82 <br /> Sub total <br /> Process fee Waived - $20.00 <br /> Total - $918.82 <br /> Comments: One time Clean Up <br />