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D <br /> RQNIC! TAL SERVICEsi, <br /> an oaquin County Permanent HHW Boit ;ivrr acuity JUN 0 <br /> s�t,m R.A l3r$drd stmt 4 2009 <br /> t on,CSA 95206 ENVIRONMENT H <br /> irect: 209-46&5670 /SERVSS T <br /> sx: 209-468-5672 <br /> CESQG DATA SWEET $ WAIVER <br /> Business hifomwbon <br /> Business waiver <br /> State and federai hazardous waste I aws Hma the use of•this type of waste-*,ilection programs to those businesses that <br /> generate less than 100 kilgrams(27 gallons or 220 pounds)of hazardous waste per month. Susinesses that generate morti <br /> than this amount are required by lay F to use a licensed hazardous waste hauler to manifest and transport their waste. <br /> Therefore, in carder to participate in this program, you must sign the following vaasiver of viability. We reserve the right to rev ew <br /> your annual manifests or consult wit i the County Environmental Health Department to determine your eligibility for use of this <br /> program.. Thank you. <br /> l certify the business that l am repre 5enting is a °wond tionally Exempt Small Quantity;generator('.'ESQG.L who generates ro <br /> more than 100 kilorams{27 gallons r220 pounds}of hazardous waste per month based on an annual average and t, the <br /> representative of the CESOG,understand the maximum quantity of waste accepted at the time to disposal is.27 gallons or <br /> 220 pounds and any disposal costs incurred duall be the responsiblitity of the CESQG to pay at the time of dir.posal. <br /> � isigna re <br /> t <br /> DO NOT WRITE BELOW THIS LINE <br /> NVENTORY <br /> 'o oe;:�ornpleted by coilectior,personnell <br /> iters Yar�or�s l�ounUs +?of Cont. Price Toial <br /> mel '' �' a , 2/ 1 tiA <br /> [Sub total <br /> Process fey ' `!_'"" <br /> _ - F Y i $20.i10 <br /> Total r ✓o'G b <br /> iaomments. �� <br />