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SAN JOAQUIN COUNTY <br /> : - <br /> ;�.r ENVIRONMENTAL HEALTH DEPART?.IENT Return this form by the <br /> 600 East Main Streef, Stockton,CA 95262-3029 12 of each month <br /> ' ' I Telephone:(209)468-3420 Fax:(209)464-0138 Web:aAvw.sjgov.o4ehd <br /> E//PT GE LEANER`S REPORT ,� / <br /> Come: l 7 of 4 f(� L Report t e th at: v y <br /> alall ea r <br /> Company Fu <br /> Company Address: 77? a.� �`� `l �� Signatur <br /> .� Stree!A#4ess car Z code <br /> m <br /> All Information submitted must be complete, accurate, and legible <br /> TLkL <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLOiVS JR) pF—EN NAME OF TREATMENT <br /> COl <br /> PUMPED PROPERTY OWNER PUMPED IG) uzEA STRAP FACILITY <br /> r..� PLEASE INCLUDE STREET R, DIRECTION, STREET NAME AND CITY C CFEkl3CAL <br /> O <br /> F- C� <br /> Cty <br /> City <br /> city C0 201 <br /> CV - -1 1 LTI <br /> m PE MIT/SE <br /> m <br /> � r <br /> tD C <br /> m <br /> Ln <br /> Dcityo <br /> J z <br /> O <br /> 0 C' <br /> CE <br /> H <br /> city <br /> cry <br /> Z <br /> O c <br /> L� <br /> H cr1 <br /> J c U <br /> Q <br /> c 1 <br /> O LSl <br /> LL <br /> v <br /> a <br /> C C D <br /> a� <br /> 4 C E <br /> f— <br /> rn CkyI a <br /> i a> <br /> m - > <br /> EHO SEPTAGE CLEANERS REPORT 42-04 <br /> a' <br /> u 1 407 <br />