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`OFit <br /> hi • ' " <br /> Working for You <br /> San Joaquin County Household Hazardous Waste Facility <br /> 1. Date: <br /> 2. Name: Jp \ � <br /> Address: �j��� �"�l �C � a-cA q <br /> City: Zip: 1 Z u <br /> 3. tns de City Limits H Outside City Limits (check one) <br /> I hereby swear that the waste I am deliverying today was generated in San Joaqin County by a <br /> residence and not in a business endevor. Business waste is a waste generated in the course of <br /> 4. doing business, even if tha usiness is operated out of your home. Business waste also includes <br /> waste gener ed by hurc s, sc ool , government agencies, non-profits, property management or <br /> apartment c le an ment, anches and farms and s.troage com anies. 1 <br /> Sin e: � 5 1� Z) <br /> 5. 1 a delievenn aste fr # f households today. <br /> 6. 1 hav sed useh d Hazardous waste Collection Facility # <br /> 7 1 heard about this program throu the following: (circle an that apply) <br /> Household <br /> Hazardous Wast <br /> Brochure <br /> Recycling Guide/ n <br /> 1 : (U <br /> Phone Book Website <br /> Flyer/Mailer <br /> Newspaper Ad/Article Called Solid Waste <br /> name 468-3066 <br /> Other: <br /> (describe) <br /> Word of Mouth <br /> Official Use Onlyo s <br />