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o <br />7,• z000 <br />c'028`, <br />CERTIFICATE OF DISPOSAL/RECYCLING <br />purity Regional Household Hazardous Waste Program <br />Ay Household Hazardous Waste Facility <br />kidgeford Street, Stockton, CA 95206 <br />ice: (209) 468-3066 <br />oh la <br />F5 <br />Date <br />55-23 <br />iA tode & Telephone Nionber <br />1-6L_k7ei)--) q 26 C 26 — 13— 6,773 <br />I declare, under penalty of perjury, that the waste I <br />brought to this facility was generated by a resident and <br />was not generated by a business. <br />Material Recelvack <br />61 VC 1/44) ‘1 t <br />'Quanfity ( J;) <br />C.."0YOTAA- <br />DateProcessed <br />-6151Q1.3 <br />AkVSG, I 212-d- <br />To be coati:dated:by FINW Facility Staff Member <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 Name (print): 07 , U' 4 ail kik.,110 <br />Environmental Heatth Referral:- 41/10 <br />liVehicle License Plate Number (if *applicable): A