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M00M0■ <br /> SAN JOAQUIM COUNTY � <br /> EMJIRONIAEMfA! HEALTH DEPARTMENT <br /> Return this form by the <br /> 600 East Main Street,Stockton, CA 95202-3029 92"'of each month � <br /> Telephone:(209}468-342D Fax- (209)464-0138 Web:%v6vm.sjgov.orgleExl �I <br /> =" <br /> y <br /> o <br /> SEPT GENER S REPORT Repofor tth of:Company Name: / L� <br /> year � 3 �0 <br /> Signat�Company Address: e 777A.6 �CQ-3 3d <br /> Steil Add res s c>� DP cods � <br /> O <br /> 3 <br /> All information submitted must be complete, accurate, and legible <br /> o DATE NAME Of BUSINESS OR ADDRESS VITERF WORK WAS DONE GALLONS (R) ,xE��E�>u NAME OF T12f11TIRENT � <br /> PUMPED PROPERTY PUMPED (G) GRFl5E7RAP FACILITY <br /> PLEASE INCLUDE STRF <br /> PUE7 r, DIRECTION, STREET RAPE AND CITY C CHO®CAL H <br /> Tl <br /> Z <br /> .o <br /> D ` D <br /> CIV <br /> O <br /> c r <br /> 0 <br /> � � r <br /> I <br /> T 1 201 <br /> Cty <br /> I <br /> E1q\jjR0NMEN <br /> cly 1 ES <br /> CD <br /> w <br /> w <br /> CI <br /> i <br /> City <br /> I <br /> I C' <br /> O <br /> Otf <br /> R1 <br /> m <br /> City <br /> O <br /> I ~' <br /> ciry w <br /> OJ <br /> I <br /> I <br /> i <br /> C✓rt <br /> Et ID 42-04 SEPTAGE CLEANERS REPORT <br /> 16f�f07 <br /> I <br />