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_YCLABLE MATERIALS REPORTING F <br /> rCEASE PRINT OR TYPE ALL INFORMATI(j <br /> (see Instructions on reverse) <br /> WHEN COMPLETED , RETURN THIS FORM TO <br /> THE LOCA L HEALTH OFFICER OR OTHER AUTHORIZED PUBLIC OFFICER A T: <br /> OCT -5 AN 8' 42 SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 445 N. SAN JOAQUIN STREET <br /> P.O. BOX 2009 <br /> STOCKTON, CA 95201 <br /> (209) 468-3427 <br /> 1. DATES OF REPORTING PERIOD: Beginning Date: November, 1995 Ending Date: November, 1997 <br /> II. FACILITY THAT RECYCLES THE MATERIAL(Please print or type). <br /> A. RECYCLING FACILITY <br /> Facility EPA Identification Number CAD-982060634 <br /> Facility Name Ad Art / Electronic Sign Corp. <br /> Facility Address 3133 N. Ad Art Rd . <br /> City Stockton County San Joaquin <br /> State Calif. Zip 95215 <br /> Contact: Last Name Shanley First Name Lorin <br /> Telephone ( 209)931-0860 FAX ( 209 ) 931-5706 <br /> B. OWNER OR OPERATOR OF THE RECYCLING FACILITY. <br /> Name Ad Art / Electronic Sign Corp <br /> Address 3133 N. Ad Art Rd. <br /> City Stockton State -Calif. Zip 95215 <br /> Telephone (, nq)q31 -08ho FAX ( 209 ) 931-5706 <br /> 111. GENERATOR OF THE RECYCLABLE MATERIAL(Please print or type). <br /> Was the generator of the material the same as the recycler? ❑No RlYes <br /> If Yes, than leave Section Ill blank and proceed to Section IV. <br /> A_ GENERATING FACILITY. <br /> Facility EPA Identification Number. <br /> Facility Name <br /> Facility Address <br /> City-" <br /> ._ _ County <br /> State Zip <br /> Contact' Last Name First Name <br /> Telephone FAX <br /> B. OWNER OR OPERATOR OF THE GENERATING FACILITY. <br /> Name <br /> Address <br /> city State Zip <br /> Telephone FAX <br /> Rev:5/1892 Page r of 2 <br />