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�l <br />an <br />F"W"10"rw <br />San Joaquin Co, HHW <br />7,950 South R.A. Bridgeford $t CESQG DATA SHEET & WAIVER <br />StOcktOn, CA 95206 <br />Telephone (209) 468.56713 JC)8#: <br />F2x:(208) 468-5672. <br />SA000046 <br />": � -5 / � C /� a /0 <br />State, and tbdoral hazardous waste lows omit th9 use qr thlS typ$ Ofwagtp "110000 programa to those quBtneS&69 thst <br />90VI61100 leas then 100 kiigrams (27 gallons or220 pounds) of hazardous waste per month. Businessesthat generpto more <br />than this amount are repulnad by law to use a licensed hazardous waste hauler to manifest and trenaport their waste. Therefore, <br />In order to participate In tats program, you must sign the iollowlng vt lstvar of liability, We, reserve the right to review your annual <br />manifests or consult with the County .Enulronmental Health Department to determine your oUgINIffy fbr use of this program. <br />Thank you. <br />I eerl►fy Uta business that I am representing Is s Conditionally Exempt Sm811 Quantity Generator (CESCIG) who generates no <br />more than 100 kilorartts (27 gallons or 220 pound$) Of hazardous waale per month based on an annual average and I, the <br />representative of the CESOO. understand the maximum quantity of waste aecepto at the time for 01sposat is 27 gallons or 220 <br />pounds and any disposal costa Incurred shall be the responsiblitity of the CE940 to pay at the time of disposal. <br />DO NOT WRITE BELOW THIS LINE <br />1N11EMTORY <br />(To be completed by colladlan pereonn <br />t..,... 1�. e $S <br />r�r■■rr <br />