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OCT-27-2008 18:29 CITY OF LODI 209 333 6718 P.38 <br /> Uor <br /> ENVIRONMENTAL SERVICES" <br /> San Joaquin County Permanent HHW Collection Facil ty <br /> 7850 South R.A 6rdgeford Street <br /> Stockton,CA 95206 <br /> Direct: 208-068-5670 <br /> Fax. 209.460-5672 <br /> CESQG DATA SHEET & WAIVER <br /> eudners Irdarrrtetlon <br /> City Of Lodi ( Public Works) John <br /> 221 W Pine St. <br /> Lodi Ca 95241 209-3336800 Ext2591 <br /> eyslnew waWer <br /> State and federal hazardous waste taws limit the use of this type of waste collection programs 10 those businesses that <br /> generate less than 100 kilgrams(27 gallons or 220 pounds)of hazardous waste per month. Busiriesses that generate more <br /> than this amount are required by IoW 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 follow"wasiver of liatwity.We reserve the right to review <br /> your annual manifests or consult with the County Environmental Health Department to determine your eligibility W use Of this <br /> program. 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 kitarams(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 weate aaepied et the time fa disposal is 27 gallons or 220 <br /> pounds and any disposal costs incurred shall be the tagponslblithy of the CESQG to pay at the time of disposal. <br /> 10/16=8 1:00 PM I <br /> Signature <br /> Do NOT WRITE BELOW THIS UNE <br /> INVENTORY <br /> fro be completed by collection Peraonnet) <br /> Item Gsaons Pounds ref Cont. Price Total <br /> Fluorescent Lannips 4 FT 853 2206 0.701, 597.10 <br /> Cm 50 100 1.50 75.00 <br /> Metal Halide 236 582 3.50 826.00 <br /> High Pressure Sodium 527 2182 1.50 790.50 <br /> M5krciny Vapor Btdbs 6 19 3.50 21.00 <br /> NOWPCA Ballast 51 17 0.70 35.70 <br /> NON-PC8 BaAast Electric 144 48 0.70 100.80 <br /> PCB Ballast 60 20 0.80 48.00 <br /> Fluorescent Lamps 8 FF 25 20 0.70 17.50 <br /> Sub total 2,511.60 <br /> Process fee $20.00 <br /> Total $2,631M <br />