Laserfiche WebLink
11/0R/2008 11:11 2094685672 CLEAN HARBORS PAGE 02/03 <br /> ELM a& <br /> oil L <br /> ENNIRONUENTAL SERVICEV <br /> 8811 Joaquin County Permanent HHW Collection Faclitpy <br /> 7850 South R.A Srklpford Street <br /> Stockton,CA 95206 <br /> Direct: 209-168-567o <br /> Fax: 209.468-5672 <br /> t#taainm frtfprrreation CESQC DATA SHEET&WAIVER <br /> SJC (Park& Rea) Hugh Mullen <br /> 11793 N. Micke Grove Rd. <br /> Lodi Ca. 96240 209.331-204$ <br /> eersr. s Wsciver <br /> State and fOderal hazardous waste laws limit the use of this type of waste collection programs to those businesses that <br /> generate less than 100 kilgroms(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 faitowing washer of liability,We reserve the right to review <br /> Your annual manifests or consult with the County Environmental Health Dapattment to determine your eligibility for use of this <br /> program. Thank you. <br /> I certify the business that I am representing is a Conditionally E3rnpt Small Quantity Generator(CESt lG)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 respwribiitity of the CESQG to pay at the time of disposal. <br /> tg1012i}08 9,36 AM r <br /> ignature <br /> 00 NOT WRITE BEL THIS LINE <br /> -Z <br /> INVENTORY <br /> (To be completed by collection personnel) <br /> Item Gallons pounds #of Gone {'rice Total <br /> Flammable Li ttid 13.9 118. 1 5.30 73.56 <br /> Sub total 1 73.56 <br /> Process fee - $20.00 <br /> Total - $93.56 <br />