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RECEIVED 'mom' <br /> SAN JDADUIN COUNTY o <br /> Return this form by the <br /> ENVIRONMENTAL HEALTH DEPARTMENT FU <br /> 720 of each month <br /> « 600 East Main Street, Stockton, CA 95202-3029 U C T 0 9 20j2 N <br /> _ �*g� tJ <br /> • _ Telephone:(209)468-3420 Fax:(209)464-0138 Web:wWlw- jgov.orglettd mY <br /> N <br /> SEPT GE CLEANER'S REPORT ENVIRONMENTAL HEALTH �} <br /> n Report or of / ear��o�• m <br /> Company Name: ) m <br /> o Company Address: (R� Signature—moi <br /> StM Addol C4Y LP Cod- <br /> All <br /> odAll information submitted must be complete, accurate, and legible <br /> N DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE UGALLOINSR) xEsorNNitAL NAME OF TREATMENT <br /> G) g3Er5E rsu PUMPED PROPERTY OWNER FACILITYLEASE INCLUDE STREET I, DIRECTION• STREET NAIIE AND CITYG CF©9CAL <br /> ��a O o 3 <br /> a73y f �oL a ' o 0 <br /> z o : <br /> City <br /> Gay <br /> N <br /> VI <br /> Ca CityA <br /> GitY <br /> Cft <br /> l0 <br /> W <br /> 1 <br /> O <br /> Nr : <br /> city <br /> CJbF <br /> City <br /> 0 <br /> ID <br /> A <br /> Q <br /> d <br /> m <br /> r <br /> W : <br /> M <br /> CdY <br /> 7 <br /> r <br /> SEfiA6E CLEANERS REPORT <br /> EHD a�os r <br /> taz»7 <br />