Download Inventory

So Co HTWF
Petaluma Office
500 Mecham Rd #5
Petaluma, CA 94952
Telephone (707) 795-2025
Fax (707) 795-2071
CESQG INVENTORY FORM
Company Name:
Contact:
Address:
City:
Zip Code:
Phone No.:
County:
(
)
*EPA ID#:
*If you do not have an EPA ID#, you may call (800) 618-6942 or www.dtsc.ca.gov to obtain form 1358.
Appointment /Date (if known):
Type of Waste
(example): Aerosols
Quantity
4
Size and Type
of Container
Liquid/
Solid
5 gal plastic
bucket
Liquid
To be filled out by
Clean Harbors
Cost per
lb./gal.
Total Cost
Sub Total (Varies upon waste weight)
Processing Fee
Total to be paid by CESQG (Make check payable to Clean Harbors Environmental)
If you need more room please attach another sheet and list as specified on this form.
I certify the business that I am representing is a Conditionally Exempt Small Quantity Generator
(CESQG) who generates no more than 100 kilograms (27 gallons or 220 pounds) of hazardous waste
per month based on an annual average and I, the representative of the CESQG, understand the
maximum quantity of waste accepted at the time of disposal is 27 gallons or 220 pounds and any
disposal costs incurred shall be the responsibility of the CESQG to pay at the time of disposal.
Signature
Date
G/Forms/HHW-CESQG/CESQG Inventory fORM