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A <br />1111111111 II I I I II---------------- <br />I <br />USED OIL ONLY (vp'( VA51e c4t-LS (4 <br />Facility Name: �6} Ct- ' (A-V)"(3 Q ) <br />Facility Street Address: 71, 1 N DU S i RI 0 L AVE <br />E <br />City: R 10 G f,? <br />Contact Person: jy 61 U ti I T i� IrvL Phone: <br />I certify that the only hazardous waste generated by the above referenced Facility is USED <br />OIL and that the total amount generated per year is less than 5 tons. <br />Signed: �fcyn,�A e2'),z <br />A Division of San Joaquin County Health Care Services <br />