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San Joaquin County <br /> Environmental Health Department <br /> 1868 E Hazelton Avenue, Stockton, CA 95205 <br /> (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd <br /> Public Works Waste Pickup and Transportation <br /> i. Date: i z. COC6AYWBX <br /> 3. Time: 4. EPA ID #: CAS111111039 <br /> s. Transporter Registration #: 6148 <br /> s. Reporting Party: PW SO CHP ®Others: �f.t��� i ! <br /> 7. Waste Pick-up Address: WQe� KcvoLJc,- LK - <br /> a. Destination: 7850 S R A Bridgeford, Stockton, CA 95206 .e . <br /> B. Containers 10. Waste <br /> # Quantity Size Description <br /> 1 A �iDrox rz�-� e) y I$9G (�oics in5 ,'vl <br /> M <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> ii. Emergency Contact <br /> Environmental Health Department: (209) 468-3420 <br /> 12. Special Instructions and Other Comments <br /> 13.Signature: <br /> 14. Inspector Name o �✓ / Z is.Title: /� <br />