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06 / 11 / 2021 1 : 31 PM FAX 2699488625 MICE SAtii' <br /> CERTIFICATE OF DISPOSAURECYCUNG <br /> San Joaquin CountywReglonal Household Hazardous Wa PF09MM ;, .,' <br /> San Joaquin County household Hazardous W80te IF=acility <br /> 186ft $ouch R, A Bridgetord Street Sfidcicton, CA 9,520 0 � . <br /> Administrative O f oom (209) 46MO66 <br /> customer infonnetton <br /> Nwne (print) Cuba <br /> Street Address <br /> 14;1011 F At 6 <br /> 6ktl2n 64t d5 9 7 <br /> Ideders, under penalty ofpe4dry, Mat ft vmata f Cus rnerSl stuff <br /> bmughtlaftfO* vmgmratedbyatmidaWand J <br /> was not generated by a businm* <br /> MIRK M Pewpirocenow <br /> 14 Cat <br /> d <br /> 'fdl8a Campi§leQ;�l f�(H1lIt �l8ty $ f6�g21' <br /> t#�lt �� �'r#+�►t�dntB�feo <br /> E The Sen Joaquin County, Household Hazardous Wasm Facility certifies acceptance of the <br /> z material referenced an this document, The material has been managed in accordance <br /> with United States Environmental protection Agency and Stag of California Environmental <br /> Protection Agency wast anagement regulations. <br /> atpff Member S nature: fl <br /> daLA <br /> low <br /> Stuff Member Name int A4 A <br /> nvimnmet►te� ! inssk Re#m I: . N <br /> OM* Baena Pian Number if Mbwa <br /> ' - r <br />