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CleanHarbar <br /> EIMROMMENTAL SERVICEr <br /> San Joaquin County Permanent HMW Collection Fadlity <br /> 7850 South R.A Brldgeford Street <br /> Stockton,CA 95206 <br /> Direct: 209-468-5670 <br /> Fax: 209-468-5672 <br /> Inventory Form t'INaste Disposal Receipt <br /> Houseflcdd Information <br /> Name:Simplot Phone'. <br /> Address: 4863 E Carpenter <br /> City.Stockton Ca 95215 <br /> I hereby swear that the waste I am delivefing today Was generated in San Joaquin County by a residence and not <br /> in a business endeavor. Business waste is a waste generated in the course of doing business,even if that <br /> business is operated out of your home. Business waste also includes waste generated by churches,schools, <br /> government agencies, non-profits, property management or apartment complex management,for profit ranches <br /> Datle: 7-2-09 Time: 10: Signatur+a <br /> Do NOT WRITE BELOW THIS LINE <br /> INVENTORY <br /> (To be muipleted by Wk-drion personnel) <br /> Item Gallons Pounds <br /> Paint Related Material 19.18 163 <br /> Comments: Referred by,Environmental Health <br />