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ENVIRONMENTAL SERVICES' <br />San Joaquin Co. HHW <br />7850 South R.A. Bridgeford St CESQG DATA SHEET & WAIVER <br />Stockton, CA 95206 <br />Telephone (209) 468-5670 <br />Fax: (209) 468-5672 <br />Business Information <br />Compan Name: Motor Guard <br />sheet Address= 580 camegie street <br />manteca,ca 95337 <br />CAL000181286 <br />Code: <br />JOBtF: 6J2820636 <br />SA000046 <br />Tim <br />E-mail: <br />Code 8 Telephone tk 209-239-9191 <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 I, the <br />representative of the CESQG, understand the maximum quantity of waste accepted at the time for disposal is 27 gallons or 220 <br />pounds and any disposal costs incurred shall be the responsibility off the CESQG to pay at ime of disposal. <br />8/20/2010 1 9:53 <br />1*nrn <br />WRITE BELOW THIS <br />INVENTORY <br />(To be completed by collection personnel) <br />u 1— I /_..1 D.:..e I Inif TM.I <br />fluorescent lights <br />lkaline batteries <br />lead <br />acid batteries <br />