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USED O L ONLY <br /> Facility Name: <br /> Facility Street Address: <br /> City: �j <br /> Contact Person: C),, <br /> M ��t2 <br /> Phone: <br /> I certify that the only hazardous waste gen tythe above refere ced Facility is USED <br /> er year is less t s• <br /> OIL and that the total amount gen p Y <br /> Signed: <br /> A Division of$an Joaquin County Lfl Cam Stmcas <br />