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EIY1II9011ME11TAL SERVICES' <br /> San Joaquln Co.HHW <br /> 7850 South R.A.Bridgeford St CESQG DATA SHEET&WAVER <br /> Stockton,CA 95206 <br /> Telephone(209)468-5670 JOBM 6J257863 <br /> Fax:(209)4685672 SA000046 <br /> Business lnfumnation <br /> Naim; Mecca E u mere R Daffy Kunkle <br /> strep Address; 7030 C E Dixon E-mail: <br /> rStareZ Gree: Stockton Ca 95206 Lear Code a Telephone e: 209-983 8790 <br /> EPA#CAL000334569 rear Ca4a 6 Fex Number <br /> 9aarn0aa Wel•ar <br /> State and federal hmaclous waste laws limit the use of Inis 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.Bualnesses that generate more <br /> than this amount are required by law to use a licensed hazardous waste hauler to manifest and transport their waste.Therefore, <br /> In order to PsMcipate In this Prograrn,you must sign the following washer of Itablilty.We reserve the right to review your annual <br /> manifests or consult with the County Envkptmmtal Health Department to determine you eligibility for use of this program. <br /> Thank you <br /> I 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)LN hazardous waste per month based on an annual average and I,the <br /> representative of the CESQG.undembirrrd the maximum quantity of waste accepted at the time for disposal Is 27 gallons or 220 <br /> pounds and arty disposal costs incu"d shall be the responslbigity of the CESQG to pay at the time of disposal. <br /> ignature <br /> 11/6/2009 11:02 <br /> DO NOT WRITE BELOW THIS LINE <br /> INVENTORY <br /> go bo compieted by wle n pe W, <br /> Item allbaJ Gal Price Unit ?olal <br /> Waste oil contaminated 3,5 30 $5.30 al 1 $18.71 <br /> Subtotal $11371 <br /> lProcassing Fee $20.00 ea. <br /> Total 538.71 <br /> �D� MUM tC <br />