Conditionally Exempt Small Quantity Generator (CESQG) Tracking Sheet

PART 1 - BUSINESS INFORMATION

Apointment Date

Appointment Time

Phone

Fax

EPA ID Number, if any

Haz Mat Registration Number, if any

Name of Business

Mailing Address

Address Line 1

City

State

Zip Code

Street Address - if different from mailing address

Address Line 1

City

State

Zip Code

PART 2 - WASTE DESCRIPTION

Acids/Bases

$1.00 /lb

Fluorescent Tubes

$0.20/ft

Contaminated, Used Motor Oil or Gasoline

$1.00/lb

Aerosols

$1.00/can

Fluorescent Bulbs

$1.00/bulb

Oil Filters

$1.00/each

Antifreeze

$1.00/lb

Gas Cylinders: Under 5 gal

$20.00/each

Oxidizers

$1.00/lb

Asbestos (Non-friable only)

$1.00/lb

Batteries:(Alkaline, NiCad/ Lith)

$1.00/lb

Pesticides (Liquids/Solids)

$1.00/lb

Flamable Liquids

$1.00/lb

Latex Paint

$0.50/lb

Reactives

$5.00/lb