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lit <br />ENVIRONMENTAL SERVICE <br />San Joaquin County Permanent HHW Collection Facility <br />7850 South R. A Bridgeford Street <br />Stockton, CA 95206 <br />Direct: 209468-5670 <br />Fax: 209-468-5672 <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 <br />review your annual manifests or consult with the County Environmental Health Department to determine your eligibility for use <br />of this 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 1, the <br />representative of the CESQG, understand the maximum quantity of waste accepted at the time fb disposal is 27 gallons or <br />220 pounds and any disposal costs incurred shall be the responsiblitily of the CESOG to pay at the time of disposal. <br />12/5/20081 3:10 PMISi nature <br />9 '0Q0" V <br />DO NOT WRITE BELOW THIS LINE <br />INVENTORY <br />(To be completed by colleallon personnel) <br />GaAons Pounds # of Cont Price Total <br />Paint Related materials <br />Comments: <br />