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` 4 <br /> -------------------------------------------- .................---------•------------------—......... <br /> USED O ONLY <br /> Facility Name: <br /> Facility Street Address: D <br /> City: <br /> Contact Person: //dN v So K z�, Pbone: 2, ?) <br /> I certify that the only hazardous waste generated by the above referenced Facility is USED <br /> OIL and that the total amount gene per year Ossthan 5 tons. <br /> '7 <br /> Signed: <br /> A Division of San Joaquin County Health Care Services <br />