Laserfiche WebLink
RECYCLABLE MATERIALS REPORTING FORM <br />PLEASE PRINT OR TYPE ALL INFORMATION <br />(See Instructions on reversa) <br />WHEN COMPLETED, R E T U n N THIS FOR W TO <br />THE LOCAL HEALTH OFFICER OR O T 11 E R AUTHORIZED PUBLIC OFFICER AT: <br />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 />I. 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 />S. 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 (2Cq) 931 -C86n FAX (209)931-5706 <br />III. GENERATOR OF THE RECYCLABLE MATERIAL (Please print or type). <br />Was the generator of the material the same as the recyclor? 0 No 0 Yes <br />1l Yes, then leavo Section 111 blank and proceed to Sat -lion IV. <br />A <br />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 />County <br />Zip <br />First Name <br />FAX <br />Address <br />City State Zip <br />Telephone FAX <br />Rev: 511"2 Page t of 2 <br />