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rmt,war675"r�% <br /> _ <br /> ENVAR43SMENTAL SERVICES' <br /> San Joaquin County Permanent HHW Collection Facility <br /> 7850 South RA Bridgeford Street <br /> Stockton,Ca 95206 <br /> Direct:209-468-5670 <br /> Fax:209-468-5672 <br /> Inventory Form/Waste Disposal Receipt <br /> Name: I On (11 L/ )I nd,)EC Contact: <br /> Address: 1 t'1 <br /> J <br /> City: S�(lC k �v1 Zip Code: ��C Phone No.: (a(A �Og i 7 F3 3 <br /> County: C A. t n *EPA ID#: <br /> *If you do not have an EPA ID#, you may call (800) 618-6942 to obtain one. <br /> Event Location/Date (if known): San Joaquin County Household Hazardous Waste Facility <br /> To be filled out by <br /> Type of Waste Quantity Size and Type Liquid/ Staff <br /> of Container Solid Date. Initial/Signature <br /> (example):Latex Paint 4 S gal plastic Liquid <br /> bucket <br /> L i 0 <br /> If y n d more room please attach anothe heel and)1st as specified on this form. <br /> t afore Date <br />