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o <br /> �F <br /> working for You <br /> San Joaquin County Household Hazardous Waste Facility <br /> 2 Name <br /> Address: <br /> Zip �S2 S <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 business, even if that business is operated out of your home, Business waste also includes <br /> waste generateq by ch rches, cools, government agencies, non-profits, property management or <br /> apartment com ex malinageme t, for prori ran es and farms and stroage companies. <br /> Signature:, <br /> 5. I am delivering �aste _ 1 households today. <br /> 6. I have us�d i�Household-Hazardous waste Collection Facility # <br /> 7 1 heard about this program through the following: (circle all that apply) <br /> Z Household <br /> Hazardous Waste <br /> w 6� <br /> Brochure <br /> Recycling Guide/ " <br /> Phone Book -" Websit <br /> Flyer/Mailer <br /> Newspaper Ad/Article Called Solid Waste <br /> name 468-3066 -- <br /> Other: <br /> (describe) <br /> 4 Word of Mouth I 0y <br /> Official Use Only a <br />