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RECEIVED SAN JOAQU#N COUNTY Return this form by the <br /> G <br /> �• _.��';., ENVIRONMFNTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 �{_ 12tof each month <br /> Telephone:(209) 468-3426 fax: (209) 454-0138 Web:w+,wu.sjgov.arg*' —Z ( <br /> SEPTAGE CLEANERS REPORT <br /> ENVtiRONM�NT Y RE ETH Report for the month of: sPA c y�=� year <br /> Company Name: <br /> Signature:�� <br /> Company Address: f J`` re Zip Cade <br /> SUeet Address City <br /> All information submitted must be eom tete accurate, and le ibis GALLOKS (R? R¢siDExnAL NAMEOFTREATMENT <br /> ggYE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE PUMPED <br /> (4) GREASE TRAP FACILITY <br /> PUMPED PROPERTY OWNER PLEASE INCLUDE STREET A. DIRECTION, STREET NAME AND CITY C CHEMIRAL <br /> r~ cit <br /> �r <br /> r <br /> 0 cit <br /> M <br /> In cil <br /> L CI <br /> d <br /> Cil <br /> C <br /> •+ Cit <br /> R <br /> E <br /> Cil <br /> Cit <br /> M <br /> Ci <br /> C <br /> W <br /> E Cit <br /> C <br /> cit <br /> L <br /> � Cit <br /> C <br /> W <br /> CI1 <br /> R1 <br /> ID Cit <br /> Cit <br /> r <br /> 0 <br /> Cit <br /> ctr <br /> 0 <br /> SF_PTAGE CLEANERS R=PORT <br /> .13 <br /> =HD 42.04 <br /> �" 1Qlyl07 <br />