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11/1312008 14:49 2093312012 SJC PARKS PAGE 05/14 <br /> _. ia• VG-r , CJUU 11.11 s.r10�00JO/L UL-A AN HAHESUKI�:; PAGE 02/03 <br /> !a H a Mff S", <br /> Est AL 39IRVICES8 <br /> $an Joaquin Courrly€orrnan®nt M14W Cbiit n Facilfty <br /> 7850 South R A ONUefatt!Street <br /> Stockton,CA 95206 <br /> Direct, 209 S70 <br /> Fax 209-468-5672 <br /> CESOG DATA SWEET&WAIVER <br /> i�trslrsmmaa tryfrDevon <br /> SJC (Park& ReG) Hugh Muff n <br /> 11 M N. Micke Grove Rd. <br /> Lodi Ca. 95240 20-331-204-A <br /> Qualm=v t fv4w <br /> state and federal hszardous waste laws liMit tha use of this twe of waste collection programs to thane businesses ttmt <br /> generate less than 100 k1l9fams(27 gallons a'P-20 pounds)of hazardous waste Per month.BUs;nesses that generale more <br /> than this amount are mquirred by law to use a licensed hazardous waste hAuler to manifest and transport they'wagte, <br /> Them4cm,in ardor to pattirdpate in this program.you must sign the following wasNar of liability,We reserve the right to review <br /> Your annual m8nifelta of conauk with the County onvironmental Health Ciaparfinent to detentvne your eligibility lbr use of this <br /> program, Thank you. <br /> I cartify the business that I am representing is R CCndiftnsily Exempt Small Quantity Osneretor(0990M who$rsrnatafes no <br /> mare than 100 kAoramg(27 gallons.or 220 pounds)of hazardous waste per marrth bowd on an annum,average and i,the <br /> repmaentative of the CE80G,understand the maximum quantity of waste a0cepted it the time fo disposil is 27 Pions or 220 <br /> pounds and any disposal costs inushall ba the responslbi tity of the CESQ®to pay at the time of di 1, <br /> . 1(3��2iJ08 9:35 AM 3i ure <br /> 00 NOT WPJTE BELA THIS LINA <br /> INVENTORY <br /> (To be MMIetad by coleetton pemon" <br /> It Gallon pounds :a of Gant. Price To"I <br /> fammable Liquid 13.9 119 1 L30 73.58 <br /> i <br /> dub total 73,56 <br /> Ems fee - 90,00 <br /> IT tar <br /> i <br />