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i <br /> I <br /> CleanHar <br /> ENVIRONMENTAL BIERNICEs- <br /> San Joaquin Co.HHW <br /> 7850 South R.A.Bridgeford St CESQG DATA SHEET&WAIVER <br /> Stockton,CA 95206 <br /> Telephone(209)468-5670 <br /> Fax:(209)468-5672 JO13#: SJ2726796 <br /> Business Informatlon SA000046 <br /> om an Name: HowtlnftA.,11—ldr of San Joa 1 Corn an R&nmsentwG— <br /> Sheet Address: <br /> E-mail: <br /> C /Slat Zip Code: <br /> res t;ode b rete twos tt: <br /> Business waiver <br /> ea Code&Fax Number <br /> State and federal hazardous waste laws limit the use of this type of waste cogeclton <br /> generate less than 100 kilograms(27 gallons or 220 proper gram Businesses sbusinesses that <br /> than this amount are required by law to use a licensed haze ous wast hauler to manifest a d transport their waste.generate <br /> TherofOre, <br /> In order to participate in this program,you must sign the following waiver of liability-We reserve the right to review your annual <br /> manifests or consultwith the County Environmental Health Department to determine your eligibility for use of this program. <br /> Thank you. <br /> more than 100 kilograms(27 gallons or 220 pounds)of <br /> I certify the business that I am representing Is a Conditionally Exampl Small Quantity Generator(CESQG)who generates no <br /> 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 for disposal is 27 gallons or 220 <br /> pounds and any disposal costs incurred shall be the responsibility of the CESQG to <br /> pay at the time of disposal. <br /> 2/18/2010 11:35 Signature <br /> DO NOT WRITE BELOW THIS LINE <br /> INVENTORY <br /> (To be completed by collection personnel) <br /> !tern <br /> tr l th3i Gal Price Unit Total <br /> Oil Filters 140 $0.0 lbs. <br /> Fluorescent Lem s 56 $0.701bs, $39.20 <br /> Non-PCB <br /> 14 $01C lbs. $9.80 <br /> Subtotal $49.00 <br /> Processing Fee $20.00 e6. 0. 0 <br /> Tota! $ss.00 <br />