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working for YOU <br /> San Joaquin County Household Hazardous Waste Facility <br /> 1 Date: r <br /> 2�1 200 <br /> 2. Name: <br /> Address: <br /> Cit : <br /> 3, Inside City Limits Outside City Limits (check one) <br /> I hereby swear that the waste I am deliverying today was generated in San Joaqin County by a <br /> residence and not in a business endevor. Business waste is a waste generated in the course of <br /> 4. doing busine S. even if that usiness is operated out of your home. Business waste also includes <br /> waste generat d by c urche , schools ent agencies, non_profits, property management or <br /> apartm g ent, f profit ranc es and farms and stroage companies. <br /> Si at re: <br /> 5. 1 am lieverin aste from # households today. 5 aS <br /> 6. 1 have use a Ho Hazard us waste Collection Facility # 1 <br /> 6T �) J <br /> I heard about this program through the f Ing: (circle all that apply) <br /> w (Hazardous <br /> ehold -- <br /> Was <br /> o <br /> hure <br /> P I <br /> Recycling Guide/ _ <br /> Phone Book Website <br /> 4' C <br /> w <br /> Flyer/Mailer <br /> Newspaper Ad/Article Called Solid Waste <br /> name 468-3066 <br /> Other: <br /> (describe) <br /> Word of Mouth <br /> Official Use OnlyEos <br />