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p`P:YCLABLE MATERIALS REPORTING FOI <br /> PLEASE PRINT OR TYPE ALL INFORMATION' <br /> (See Instructions on reverse) CNC(x)S('<C ttZ <br /> WHEN COMPLETED , RETURN THIS FORM TO <br /> T HE LO CAL HE ALTH OFFICER OR OTHER AUTHORIZED PUBLIC OFFICER A T <br /> SAN JOAQUIN COUNTY PUBUC HEALTH SERVICES <br /> PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E WEBER AVE 3RD FLOOR <br /> STOCKTON CA 95202 <br /> I. DATES OF REPORTING PERIOD: Beginning Date: 1- 1- 97 Ending Date: /,�X-3r-`P� <br /> It. FACILITY THAT RECYCLES THE MATERIAL(Please print or type). <br /> A. RECYCLING FACILITY. 04+ 909)7069V96,I <br /> 4+ <br /> Facility EPA Identification Number l:, 0 6 <br /> Facility Name \r L ]Fnl Zil9F X&)(.M eAePQ&T1Qj <br /> Facility Address 1411-7 C-7( &IU4( .-p11)67 <br /> cityJ �Kf7J� _ County SA,J %4Q01A) <br /> /�Ia <br /> State 1. 4 L l PCeMA Zip q SZOS <br /> Contact: Last Name 04A)A e- First Name I/�4Y✓E <br /> Telephone (Z09) q66-f/Z4 FAX 6 <br /> B. OWNER OR OPERATOR OF 'T'H//E RECYCLING FACILITY. <br /> Name S"' •'"`0J l�✓//2 E P9000&I S �ul�r�orZATi u� <br /> Address Jel /Z C&f f)WAC -42105F <br /> City J' dZN State QAZip 0�-ZU S <br /> Telephone uZ o 9) y(e(e - g5 2- L FAX -(5�(r Py To <br /> III. GENERATOR OF THE RECYCLABLE MATERIAL(Please print or type). <br /> Was the generator of the material the some as the recycler7 ❑No Yes <br /> If Yes, then leave Section/it blank and proceed to Section IV. <br /> A. GENERATING FACILITY. <br /> Facility EPA Identification Number <br /> Facility Name <br /> Facility Address <br /> City County <br /> State Zip <br /> Contact: Last Name First Name <br /> Telephone FAX <br /> B. OWNER OR OPERATOR OF THE GENERATING FACILITY. <br /> Name <br /> Address <br /> City State Zip <br /> Telephone FAX <br /> Rev:5118192 Page 1 of 2 <br />