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(See Instructions an reverse) <br />CC ti P l E T E 0. R ETURM THIS FO A <br />THE LOCAL HEAL O F F I C E R O R O T H E R A U T H O R I Z E D 1. i C OFFICER AT: <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />44-s t4 —=T 3o4 E. we-6,el- Ave, -S2' F4-404- <br />P.O. Boxes --�;T 9, <br />STOCKTON, CA 95201 — O3S S <br />(209) 468-3427 <br />I. DATES OF REPORTING PERIOD: Beginning Date: 11/18/96 Ending Date <br />Ii. FACILITY THAT RECYCLES THE MATERIAL (Please print or type). <br />A. RECYCLING FACILITY. <br />Facility EPA Identification Number CAD 063036776 <br />Facility Name Pacific Coast Producers <br />Facility Address 835 S. Stockton Street <br />City Lodi <br />State CA <br />Contact: Last Name Stevens <br />Telephone (209) 334-335"2 <br />12/31/96 <br />County San Joaquin <br />Z;P 95240 <br />First Name Boyd <br />FAX (209) 367-7307 <br />8. OWNER OR OPERATOR OF THE RECYCLING FACILITY. <br />Name Pacific Coast Producers <br />Address 631 N. Cluff Ave. <br />City Lodi Slate CA ZIP 95240 <br />Telephone (209) 367-8800 FAX (209) 367-1084 <br />III. GENERATOR CF THE RECYCLABLE MATERIAL (Please print or type). <br />Was the generator of the material the same as the recycier? Q No & Yes <br />If Yes, then leave Section III blank and proceed to Section IV. <br />A. GENERATING FACILITY. <br />Facility EPA Identification Number <br />Facility Name <br />Facility Address <br />City <br />State <br />Contact: Last Name <br />Telephone <br />B. OWNER OR OPERATOR OF THE GENERATING FACILITY. <br />Name <br />Address <br />City <br />Telephone <br />Rev: &^l&92 <br />County <br />Zip <br />First Name <br />FAX <br />State Zip <br />FAX <br />Page 1 of 2 <br />