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����"' --------------- OIL ONLY <br />/' USED D <br />Facility Name, Sf f Y <br />Facility Street Address: Y72 -I E • ffV�v-' o5 -A '4• <br />City: S40Cj�4oN C 952---05- <br />, c - 95/8-0209 <br />8 21&- h ZA Phone: e� 9 <br />Contact Person: USED <br />I certify that the only hazardous waste <br />OIL and that the total amouPt-ge�rat <br />Signed: <br />Lted by the above referenced Facility is <br />year is less than 5 tons. <br />A Division of San Joaquin County ahh Cam Services <br />