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From <br />0 <br />06/Qg/2010 19:23 #143 P.002/012 <br />Me, <br />ENVIRONMENTAL SERVICES' <br />San Joaquin Cu. HHW <br />7850 South R.A. Bridgeford St CESQG DATA SHEET & WAIVER <br />Stockton, CA 95206 <br />Telephone (209) 468-5670 JOB#: 6J2869220 <br />Fax:(209) 468-5672 SA000046 <br />Company Name. Build IT Construction lCompany Representative: Jason <br />Street Address: P 0 Box 5811 E-mail: <br />City/State/Zip Code: Auburn Ca 95604 Code & Telephone W 916-220-2608 <br />Code & Fax Number <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 kilograms (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. Therefore, <br />in order to participate in this program, you must sign the following waiver of liability. We reserve the right to review your annual <br />manifests or consult with the County Environmental Health Department to determine your 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 kilograms (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 isposal is 27 go" or 220 <br />pounds and any disposal costs incurred shall be the responsiblitity a CESQG to pay at the <br />igna re <br />5/22/2010 10:42 IS <br />THIS LINE <br />INVENTORY <br />(To be completed by collection personnel) <br />Oil Filters <br />199 <br />$0. s_ <br />$- <br />Latex Paint <br />2.8 24 <br />$5.;al- <br />$14.96 <br />Paint Related Material <br />2.5 21 <br />$5.3 al <br />$13.09 <br />Acid (Inorganic) <br />7 <br />$2.10 bs. <br />$2.10 lbs. <br />$3.20 lbs. <br />$14.70 <br />$4.20 <br />$25.60 <br />Base (organic) 2 <br />Flammable Liquid 8 <br />Subtotal <br />$72.56 <br />Processin Fee <br />$20.00 ea. <br />$20.00 <br />Total <br />$92.56 <br />