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feanHarb, <br /> atnnmSERVIe - <br /> San Joaquin Co.HHW <br /> 7850 South RA Bridgeford St CESQG DATA SWEET&WAIVER <br /> Stodtlon,CA 95206 0 2413 3Y� <br /> Telephone(209)466.5670 JOB* <br /> Fax:(209)468-5672 SA000046 <br /> Business Information <br /> PyryName: ln&orCom R serrteave: <br /> met Address: Y-1,67 /)/.?a F-snail: <br /> /Sletaff Code: 1Codes Tele oa .20 9'F,3 <br /> /),4 Yr lgl—vim33VGa <br /> sea Cade E Fra Number <br /> Business Watver <br /> Stale and federal hamrdeus waste laws Iknit the use of this type of wasle collection programs to those businesses that <br /> generate less then 100 kllgrams(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 mantfest and transport their waste.Therefore, <br /> In order to participate In this program,you must sign the following waslvor of Ilablllty.We reserve the right to reWow your annual <br /> manifests or consult with the County EnWronrnental HeaRh Department to determine your eligibility for use of this program. <br /> Thank you. <br /> I tartly the business that I am representing Is a Conditionally Exempt Small Quantity Generator(CESQG)who generates no <br /> more then 100 Idlorams(27 gallons or 220 pounds)of hazardous waste per month based on an annual average and 1,the <br /> representative of the CESQG,understand the maximum quantity of waste accepted at the time for dispose[is 27 gallons or 220 <br /> pounds and any disposal costs Incurred shah be the responsrbiitly of the CESQG to pay at the time of disposal. <br /> 9 3G a r U C ignatu e <br /> DO NOT WRITE BELOW THIS LINE <br /> INVENTORY <br /> (To be compleled by collection personnel) <br /> Item a/1691 Gal price Unit Total <br /> Subtotal <br /> IlProcessing Foe 1 $ 0 ea. <br /> Tota <br /> tD <br />