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leanHarbg3 <br /> NVIRONMENTAL SERVICES" <br /> an Joaquin County Permanent HHW Collection Facility <br /> 350 South R.A Bridgeford Street <br /> tockton, CA 95206 <br /> lirect: 209-468-5670 <br /> ax: 209-468-5672 CESQG DATA SHEET & WAIVER <br /> Business Information <br /> 0/alley Arca Paul <br /> 16 E Harding Way <br /> Stockton Ca 95204 =209-466-9516 <br /> Business waiver <br /> usinesses that <br /> State and federal hazardous waste la allons'tor 220 pounds)the use of this tophaza rd <br /> waste of waste e�per pmonth Businesses that generate more <br /> generate less than 100 kilgrams( g <br /> than this amount are required b law <br /> this use <br /> program, youmust siged on the followingus waste lwas era of liability.tWe reserve ethe ir right to review <br /> Therefore, in order to participate <br /> your annual manifests or consult with the County Environmental Health Department to determine your eligibility for use of this <br /> program. Thank you. <br /> Exempt Small Quantity Generator(CESQG)who generates no <br /> I certify the business that! am representing is a Conditionally _ p <br /> more than 1 s gallons or 220 pounds) hazardous <br /> waste eaverage <br /> h <br /> representative of the CESQG, understand the maximum quantity of acepted at the time fo disposal 7 gallons or <br /> 220 pounds and any disposal costs incurred shall be the responsiblitity of th ESQG to pay at the time of disposal. <br /> �r 9.50 Aldi Signature <br /> DO NOT WRITE BELOW THIS LINE <br /> INVENTORY <br /> (To be completed by collection personnel) <br /> Pounds #of Cont. Price Total <br /> Item Gallons 160 4 $10.00 40.00 <br /> rEmp, Drurns <br /> 40.00 <br /> Sub total $20.00 <br /> Process fee $60.00 <br /> Total <br /> Comments. _ <br />