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.._CYCLABLE MATERIALS REPORTING FC.. .A <br />PLEASE PRINT OR TYPE ALL INFORMATION <br />(See instructions on reverse) <br />W H E N C O Y P L E T E 0. R E T U n N T H 1! FO R u T o <br />THE LOCAL HEALTH OFFIC E R O R 0 T 11 E R A U T H O R 1 Z E o P U t L I C O F F I CER AT: <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONDAENTAL HEALTH DIVISION <br />304 E. WEBER AVE, 3RD FLOOR <br />STOCKTON, CA 95202 <br />(209) 468-3427 <br />1. DATES OF REPORTING PERIOD: Beginning Date: All V ltP►j0&r Ending Date: rX rs sK �� <br />!995- 'S5r <br />II. FACILITY THAT RECYCLES THE MATERIAL (Please print or type). <br />A. RECYCLING FACILITY. <br />Facility EPA Identification Number z�l% - 792 0 � D <br />Facility Name p ��� Fel ~/�Nl `51 6A-) CUR <br />T <br />Facility Address 3/33 /U �y /fes � �p <br />City STcy—R7V -AJ County <br />State C'o4. <br />Zip A15 <br />Contact: Last Name �r c^)=,aFirst Name � L <br />Telephone 2.O 9' FAX —,2-09' F3/ <br />B. OWNER OR OPERATOR OF THE RECYCLING FACILITY. <br />Name <br />Address <br />City State Zip <br />Telephone FAX <br />III. GENERATOR OF THE RECYCLABLE MATERIAL (Please print or type). <br />Was the generator of the material the same as the recycler? C2No kYes <br />If Yes, then lea" Section 111 blank and proceed to Section IV. <br />A. GENERATING FACILITY. <br />Facility EPA Identification Number <br />Facility Name <br />Facility Address <br />City <br />State <br />Contact: Last Name <br />Telephone <br />B. OWNER OR OPERATOR OF THE GENERATING FACILITY. <br />Name <br />Address <br />City <br />Telephone <br />County <br />Zip <br />First Name <br />FAX <br />State Zip <br />FAX <br />Rev: _✓1&92 Page 1 of 2 <br />