<p> Sonoma County HHWF</p><p>Petaluma Apollo Site 500 Mecham Rd # 5 Petaluma, CA 94952 Telephone (707) 795-2025 Fax (707) 795-2071</p><p>CONDITIONALLY EXEMPT SMALL QUANTITY GENERATOR (CESQG) HAZARDOUS WASTE COLLECTION QUESTIONNAIRE</p><p>Listed below are the CESQG Guidelines per California Code of Regulations; 40 CFR 261.5. Please check the box that applies to your small business:</p><p>1. Does your business generate more than 100 kg/220 lbs. of Yes  No  RCRA & Non-RCRA Hazardous Waste in a month? 2. Do you accumulate hazardous waste on site? Yes  No </p><p>If yes, how much is currently stored? ______Please print address: </p><p>3. Does your business use a regular hazardous waste hauler to Yes  No  manifest and transport your waste? If yes, please print name of hauler, type and quantity of waste you dispose of per month?</p><p>State and federal hazardous waste laws limit the use of this type of hazardous waste collection program to those businesses that generate less than 100 kilograms (27 gallons or 220 pounds) of hazardous waste per month. Businesses that generate more than this amount are required by law to use a licensed hazardous waste hauler to manifest and transport their waste. Therefore, in order to participate in this program, you must sign this document claiming that you are a Conditionally Exempt Small Quantity Generator. We reserve the right to review your annual manifests or consult with the County Environmental Health Department to determine your eligibility for use of this program.</p><p>Please read and sign below: 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.</p><p>G/Forms/HHW-CESQG/CESQG Questionnaire Signature Date</p><p>G/Forms/HHW-CESQG/CESQG Questionnaire</p>