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CER7F C4= TE OF MPOS GGLOM <br /> Sari Joaquin County Homsehoid Haz ardauu Waste Fae ity �� •. <br /> 7050 South R . A Bridgeford Siietas, Stockton, CA 0520 <br /> Adminiskative Odes: (209) MMOGG <br /> cM,Mmov Br�G®Pmua� B®c� <br /> Mama ftw! a --- — _ — Date <br /> at}Pe -- <br /> Al S t _ <br /> clt�yd�''ita�l�u(� C•Y�v�a I,�a0Em1 �>�•A Zs �'r�!!�)p�6�fl� t1188�1 �P <br /> ca <br /> 1 declare, und6urponalty orpeduly, that ifto, wasille I <br /> brought to this � ORY was 9mer ated by aom,�°&1�PLt <br /> ��; and <br /> - -- was nat generated by a business. <br /> AAA= <br /> IS GAL T <br /> T'0 be complemd by Mw ru.,Illty staff (CR6muer <br /> The San Joaquin CoUrlty Household Hazardous Waste Gamility cortifiss acceptance og Me <br /> matenal referenced an this document. The Material has been fflanaged in accordance <br /> with United States E. nvironmenta Protection Agency and Stato of C69lifornim Environmental <br /> Protection Agoncy evasto management regulaiaMs . <br /> Staff Member Sipature: <br /> Staff Member Nagle (print): Lw CeJ C <br /> Erie ramperntal Health Referral : Y • N <br /> Vctai�le t i eye Mite Number (if appNc�[�: <br />