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San Joaquin County <br /> Environmental Health Department <br /> 1868 E Hazelton Avenue, Stockton, CA 95205 <br /> (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd <br /> Public Works Waste Pickup and Transportation <br /> i. Date: z. CO OO <br /> 3. Time: D a. EPA ID #: CAS111111039 <br /> s. Transporter Registrat' n #: 6148 <br /> 6. Reporting Party: W 7SO ❑CHP ❑Others: <br /> 7. Waste Pick-up Address: SLG To (X <br /> s. Destination: 7850 S R A Bridgeford, Stockton, CA 95206 <br /> 9. Containers io. Waste <br /> # Quantity 7SizeDescriptions /1 � � �I c <br /> 3 <br /> 4 <br /> 5 <br /> ��. Emergency Contact <br /> Environmental Health Department: (209) 468-3420 <br /> 12. Special Instructions and Other Comments <br /> 13.Signature: < <br /> ia. Inspector Name: <br />