Laserfiche WebLink
illeisdal Received <br /> <br />f-'1e I 9-1 vi Cs-49 <br />In0 y . 1--)i-tv iivicc41 <br />"11 1.•S If iç <br />........ <br />CE TUFOCATE OF OMPOSALRECYCIUNG <br />San Joaquin County eg!onal Househofid Hazardous Mugs P <br />San Joaquin County Household Hazardous Waste Facility <br />7950 South R. A Bridgeford Street, Stockton, CA 952 <br />Administrative Office: (209) 468-3066 <br />Customer Infonnetion <br />Name (print) <br />I re <br />194 .111 L) t)(Vitliiri / al Street Address <br />pats <br />I (//29X7 <br />ii <br />citegutigap-ood• , • <br />C4- VL , t4- 1P-/ 1e.-.(4- i declare, under pent* of penny, that the waste <br />brought to this facility was generated by a resident <br />was not generated by a business. <br />Ana tads Tebsphoras Number <br />Customer Signature <br />- <br />Obi gel DaM Processed <br />f a deil c <br />, <br />lobe completed by PIRW Facility Staff Bfiehtir <br />Certification Statement: <br />The San Joaquin County Household Hazardous Waste Facility certifies acceptance of the <br />material referenced on this document. The material has been managed in accordance <br />with United States Environmental Protection Agency and State of California Environmental <br />Protection Agency waste management regulations. <br />Staff Member Signature: <br />Staff Member Member Name (print): I ) <br />7 <br />Erwironmental Health Referral: At- <br />7 -77 (2) <br />yehicie License Plate Number (if applicable):