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i <br />NVIRONMENTAL SERVICES"' <br />an Joaquin County Permanent HHW Collection Facility <br />B50 South R. A Bridgeford Street <br />tockton, CA 95206 <br />,irect : 209-468-5670 <br />ax: 209-468-5672 <br />CESQG DATA SHEET & WAIVER <br />Business Information <br />Marina Boat sales I Dave Henninger <br />P.O. Box 729 <br />Lodi, Ca 95241 1209-367-1111 EPA ID: CAL000157203 <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 kilgrams (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. <br />Therefore, in order to participate in this program, you must sign the following wasiver of liability. We reserve the right to review <br />your annual manifests or consult with the County Environmental Health Department to determine your eligibility for 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 kilorams (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 waste accepted at the time fo disposal is 27 gallons or 220 <br />pounds and any disposal costs incurred shall be the responsiblitity of the CESQG to pay at the time of disposal. <br />2/19/2009 1:30 AM Signature <br />uy wv r rrrM i c r7CLVTY I "I L-u�� <br />INVENTORY <br />(To be completed by collection personnel) <br />Itam Gallons Pounds # of Cont. Price Total <br />Empty Drums <br />7 10 70.00 <br />Sub total <br />70.00 <br />Process fee <br />- $20.00 <br />Total <br />- $90.00 <br />