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RECEIVED <br /> a iCth'` 1 SAN JOAQUIN COUNTY <br /> r +(t(I Q 5 ZOIZ ENVIRON MENTAL HEALTH DEPARTMENT [�Rol7urnthis form by file600 East Main Street, Stockton, CA 95202-3029 12' of each month <br /> Telephone:(209) 468-3420 Fax: (209)464-0138 Web:WWW.sjgoV.org/ehd <br /> . RONMENTALHEALM <br /> CE PERMIT/SE SE/PTAGE CLEANER'S REPORT <br /> Company Name: ,F_f/ y�/C' ��1� P <br /> m Re ort for the th of: year <br /> Company Address: �C/} 7�7 L� �� /� //lr�lra �/� / Signature: � �iiLLi,tl <br /> [V Street Adal s ;M1y ➢p c.de <br /> ti <br /> All information submitted must be complete, accurate, and legible <br /> ED DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE I GALLONS {R) REStDe+nAL NAME OF TREATMENT <br /> PUMPED PROPERTY OWNERPUMPED tG) cr+EASETRar FACILITYC FLEASE INCLUDE STREET R, DIRECTION, STREET NAME AND CITY ! C CHEN60.L <br /> 6 A!ro v / d Cf �e <br /> I 144e� Al2 <br /> C41S C.1'0--- I G<r / <br /> c' <br /> city <br /> t <br /> m CIL <br /> 01 <br /> City <br /> i r <br /> i <br /> C3 <br /> On <br /> x <br /> Cc cityL <br /> city <br /> Ln C111Fw <br /> VCry <br /> of <br /> W Ci <br /> N <br /> 0 C: <br /> O <br /> A C' <br /> 0 <br /> L7 <br /> 1 G. <br /> O" <br /> Z C', <br /> 0 0 <br /> Ci <br /> J <br /> Cl <br /> Y <br /> •• EtO42_04 SEPTAGECLEP.NERS REPORT <br /> E 1W*DT <br /> 0 <br /> X <br /> LL <br />