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CERTIFICATE OF DISPOSAURECYCLING <br /> San Joaquin County'Regionag Household Hazardous Waste Fro nt <br /> San Joaquin County Household Hazardous Waste Facility '• <br /> 7650 South R.A Bridgeford Street, Stockton, CA 95206 <br /> Administrative Office: (209).468-3068 <br /> Customer Information <br /> Name(print) ®?te <br /> Street Address <br /> gp cads Tewphens file Mber <br /> P I dectam, undellpenafty ofpedur)�that the waste! custwOrtl9ndure <br /> brought to this facft was generated by a mident and CP <br /> was not generated by a husinea& <br /> a rat ;;Qaeaat 9�t op.1. IPra <br /> e tl <br /> r <br /> . � y <br /> r <br /> fi <br /> 8 <br /> c <br /> .._....o_ne___ ....................................................................................... <br /> .ro <br /> be emplaw,6y MW Fad*stwMamwo <br /> Caltifil5onee� a <br /> The San Joaquin County Household Hazardous Waste Facility certifies acceptance of the <br /> material referenced an this document. The material has been managed in accordance <br /> with United States Environmentai Protection Agency and Mate of California Environmental <br /> Protection Agency waste management regulations. <br /> Staff M®rnber Signature: ' <br /> Staff Member Name(print): ., <br /> Fnvironment al HeaQh(i.ai'arral:- N <br /> L-yehicle License Plate Number(if agpii� <br /> J <br />