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06 / 11 / 2021 2 : 28 PM FAX 2099488625 AMCE SAW 9001 / 0001 <br /> C WISM O EMS RECYCL <br /> San Joaciuin County 'ReWonaY Household Nourdous till f9m _ <br /> San Joaquin County Househord Hazardous WaSte radii ° y` ` <br /> 7,850 .South ;R. A Bridgetond $treat, Stocictn, CA 9520+ <br /> AdminfWativ+e Qf = (209) 46184066 � • <br /> Name print) bate <br /> (pho /a <br /> 8�t+�t Address <br /> tddgr, undarpemltyofpedfury, that 116wafila J Wire <br /> bMUgW to thfs fac tywas gemnod by a NNtc W &W <br /> was not generated by a bustnes& <br /> ue!" <br /> tr <br /> IN <br /> a <br /> w . . . . .. . .. . . .. . .. . ... wr . r .. . . . . . . . . . ww � wwwu + . v .r . . . ... . . . . . .wwwwewwuor .. . . . . . . . wwww � . ocwrrr. . . . .. . . www .www wraawar .. .. . . . . <br /> Ya ife campte�kby Hf�NI ��'ti� stiff"ts�e��r <br /> CBrt� ��A$o <br /> The San Joaquin County, Household Hazardous iNaste Facility certifies acceptance of the <br /> matenial referenced on this document. The matarial has been Managed In accordance <br /> with United States Environmental Protection Agency and State of California Environmental <br /> Protection Agency waste management regulations, <br /> staff f4Ramber nature; <br /> QL <br /> t SUR Member Name tint : ` <br /> � - " <wCW(Mmen#elE Refiatrala . Y N <br /> ehide Umm Plate knwd) ar (ffaggpoW <br /> i <br />