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jeanHatjOr <br /> DMRVMOItTAL sF&nmzEs' <br /> San Joaquin Co,WIN <br /> 78W South RA Bridgeford St CESQG DATA SHEET&WAIVER <br /> Stockton,CA 95208 JOBP 6J27709e1 - f <br /> Telephone(209)468^5670 - SAD00046 !iJ <br /> Fw--(209)468-6672 <br /> Blnbrus trnforrnadorr <br /> !mold Mot <br /> hfarrie: i <br /> Address: 2040 W Washy n =E-rnM&dSkfan Ca 95206 a <br /> jAm Code 6 Fax Mnntm <br /> 9uaneea WSNer <br /> State and federal hazaMous Waste laws Amit Me use of tors type of waste Conectiorl program to those business"teat <br /> generate less than 100 Wbgramrs(27 gallons a 220 pounds)of hazadoue waste per month.Businesses thate <br /> gee more <br /> than this amount are required by law to use a konsed hazardous waste hauler to msWest and trMSMIt ttairweste.Therefore, <br /> in ordar to participle in this pegnm,,you must sW the following w8ller Of lVdAity.We m6 <br /> manifests a c,mm"with the Canny EnvironmentalM rb <br /> l eaDepanent 100 determine Yourebgd)ft for use of INS Prooggram,ual <br /> Thank You. <br /> I certify the business met 1 am representing is a CondikonaM Ex9mo Small Quantity Cenemla(CESQG)who generates no <br /> aura tan too in a business <br /> (27 gallons or 220 prwrrdS)of hazardous waste per momh based on an annual average and I.Lha <br /> represeof the CESQG,undersand Me matdmum quantity of waste accepted at the time for tliap0381 is 27 gelbns a 220 <br /> nativa <br /> pounds and any disposal costs incurred stat)be the reaponsib;W of Ma,CESQG to pay at Me tune of dlsposat. <br /> nab" <br /> 9125/2010 12:28 — — <br /> 00 NOT WR)TE BELOW 1t9S VIS II <br /> WVENTOtbY <br /> (To be co.npnated M adlau n perwrm-e <br /> Rem of maJ cal prof us rota <br /> Flammable Solids 451 $t. $721.60 <br /> fammabie ti uids 40.0 340 3al $21200 <br /> 4 <br /> } Subtota $933.60 <br /> Fee $20.00 ea. <br /> Tota $953.60 <br />