Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
CERTIFICATE OF DISPOSAL/RECYCLING <br />San Joaquin County Regional Household Hazardous Waste Program <br />San Joaquin County Household Hazardous Waste Facility <br />7860 South R. A Bridgeford Street, Stockton, CA 95206 <br />Administrative Office: (209) 468-3066 <br />Customer Information <br /> <br />Name (print) <br />1 7-0 bi--7e/ a .14- 6 171 <br />Date <br />55 23 Street Add ss <br />Citylatakelp. Cede <br />S L ki e Pi et ei 5 26 - <br />Area Code a Telephone NUMber - <br />26 '1' — 13-773 . I declare, under penalty of pedury, that the waste I <br />brought to this facilNy was generated by a resident and <br />was not generated by a business. <br />Cue or 'Signature <br />C...- , <br />. <br />_........, <br />Vat** Received! . 'Quantity 001431j Date Processed <br />cj516 <br />.... <br />.." <br />a <br />, <br />-1 <br />To be corneittalty lift Facility sfarrtoterceer <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): 1.1 ail VIZI 0 <br />Environmental Heath Referral:. AP <br />Vehicle License Plate Number (if 'applicable):