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leanHarbpn <br /> NVIRONMENTAL SERVICES" <br /> an Joaquin County Permanent HHW Colle ction Facility <br /> 350 South R.A Bridgeford Street <br /> tockton, CA 95206 <br /> iirect: 209-468-5670 <br /> ax: 209-468-5672 CESQG DATA SHEET &WAIVER <br /> F <br /> tion SawGlen <br /> 1 st304 209-832-0200 <br /> Business Waiver <br /> State and federal hazardous <br /> s wasteba 220 pounds)of of thishazartype waste e of waste <br /> ercmionth Businesses that generate more than generate <br /> less than 100 quire ms( gallons <br /> amount are required by law to use a licensed hazardous waste hauler to manifest and transport their waste.Therefore, in order <br /> to participate in this pwi hrth IOUCoun y Envirronmentst sign the al Health Department owing wasiver of tolde e m ne your eligibility for ureview <br /> se of this program. <br /> manifests or consult <br /> Thank you. <br /> ty <br /> G)who <br /> gener <br /> tes <br /> I certify the business sat27 rep <br /> Bore 220 pounds)of'thazardous wase per month lbased on am ann all ave age and lano <br /> the <br /> more than 100 kilor ( gallon <br /> 20 <br /> representative of the CESQGts nd r to shall maxim the the espo sib/t ty ourn quantity of f the CESQG to pay at the timeaste accepted at the time fo )op disposal. gallons or 2 <br /> pounds and any disposal cos <br /> 5/ 9/2008 10:00 AM Signature i <br /> ,VL <br /> DO NOT WRITE BEL THIS LINE <br /> INVENTORY <br /> (To be completed by collection personnel) <br /> Gallons <br /> Pounds #of Cont. Price Total Item 100 2 10 20.00 <br /> Em t Container 50 ai Tote& 5 allon ale 30 30 N/C 0.00 <br /> used oil/em Container quart size) 30 1 1.50 45.00 <br /> Contaminated wood pl woo soaked with oil)) <br /> 65.00 <br /> Sub total $20.00 <br /> Process fee $85.00 <br /> Total <br />