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rjea laE' <br />ENVLRAMIA[yENTAL SERVICES' <br />San Joaquin County Permanent HHW Collection Facility <br />7850 South RA Bridgeford Street <br />Stockton, Ca 95206 <br />Direct: 209468-5670 <br />Fax: 209-468-5672 <br />Inventory Form/ Waste Disposal Receipt <br />Contact: <br />Address: <br />City: f;C k (-0Yy-)Zip Code:J q5a o -s— Phone No.: (ad) <br />County: SIXh jC(Ya-q'4 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 />Type of Waste <br />Quantity <br />Size and Type <br />of Container <br />Liquid/ <br />Solid <br />To be filled out by <br />Staff <br />Date. Initial Signature <br />(example): Latex Paint <br />4 <br />S gal plastic <br />bucket <br />,,.Liquid <br />L <br />t <br />fl <br />I <br />I <br />If yodngted more room please attach anotheOheet and list as specified on this form. <br />Date <br />