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Flu <br />t N, leanHarb(w <br />EIMRONMENTAL SERVICM <br />San Joaquin County Permanent HMW Collection Facility <br />7850 South R. A Sridaeford Street <br />Stockton, CA 95206 <br />Direct 209468-5670 <br />Fax: 209.468-5672 <br />Califomia Stop ITfiien phare <br />n <br />U <br />2224 Manthey Rd. <br />Stockton Ca 95246 1209-462-7627 EPA # CAL000271840 <br />Business water <br />State and federal hazardous waste laws lima the use of this type of waste collection programs to those businesses that <br />generate less than 100 kilgrams (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 most Sign tine following wasiver of liability. We reserve the right to review <br />your annual manifests or consult with the County 1=nwronmental Health t)enartment to determine your eligibility for use of this <br />program. Thank you, <br />I certify the twsiness that 1 am representing is a Conditionally Exempt Small Quantity Generator (CESQG) who generates no <br />more than 100 kiloranrs (27 gallons or 220 pounds) of hazardous waste per month t)ased on an annual average and 1, the <br />represenimlive 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 />4I17r200gl 2:30PM�Signature <br />DO NOT WRITE B IS UNE <br />INVENTORY <br />(To be completed by collection personnel) <br />Item Ganom Pounds it of Cont. Price Total <br />- <br />Comments; <br />