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C!!anHarboir <br /> ENVIR43NMENTAL 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 VM -1 1 h .fC Contact: <br /> Address: 13 "-; aG r on nUU o t'1 <br /> J <br /> City: Si rc L�rj 0 Zip Code: —Phone No.: (a l,A M' i7`C3 � <br /> County: San j a(t to *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 /> 1� <br /> (example):Latex Paint 4 Sgalplp,Ltic Liquid <br /> bucket <br /> L t <br /> If n d more room please attach anothe heel and t as specified on this form. <br /> t ature Date <br />