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` ea • <br /> Ila VIRONNIENTAL SERVICM <br /> an Joaquin County Permanent HHW Collection Facility <br /> 850 South R.A Bridgeford Street <br /> ;tockton,CA 95206 <br /> iirect: 209-468-5670 <br /> 'ax: 209-468-5672 <br /> CESQG DATA SHEET 8r WAIVER <br /> Business Information <br /> Olympic Tune/Street Rods Plus Gene Takeuchi <br /> 400 A. N Cluff Ave. <br /> San Joaquin Ca. 95240 209-334-0617 EPA CAL000304813 <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 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 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 /> ]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 to disposal is 27 gallons or 220 <br /> pounds and any disposal costs incurred shall be the responsiblitity of the CESOG to pay at the time of disposal. <br /> 1/15/2009 2:43 PM Signature _ <br /> DO NOT WRITE BELOW THIS LINE <br /> INVENTORY <br /> (To be completed by collection personnel) <br /> Item Gallons Pounds L of Cont- Price Total <br /> Fluorescent Lams 4 6 0.70 2.80 <br /> Flammable Solid Contaminated Dirt) 10 1 1.60 16.00 <br /> Sub total 18.80 <br /> Process fee $20.00 <br /> Total $38.80 <br />