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RECEIVED ' ' ' ' <br /> SAN JOAQUIN COUNTY MAR 2 0 2018 <br /> ENVIRONMENTAL HEALTH DEPARTMENT ENVIRO Return this form by the <br /> 186"8 East Hazelton Avenue, Stockton, CA 95205-6232 P�R�I�SER�HEALTH 12�' of each month <br /> Telephone:(209)46B-3420 Fax.(209)464-0138 Web:www.sjgcv.org <br /> S PTAGE CLEANER'S REPORT <br /> w <br /> Company <br /> Name: / Report forte tnth of: ear <br /> Company Address: Signature <br /> ry zgmat Address City t Zip Code <br /> 0 <br /> co All information submitted must be complete, accurate, and legible <br /> DATE NAME OF BUSINESS OR (R) RFSdF]ENTFAL <br /> ADDRESS WHERE WORKY1fAS DONE GALLONS 73AME OF TREATMENTPUMPED PROPERTY OWNER PUPIPED (G) GREASETRAP FACILITY <br /> 0 <br /> PLEASE INCLUDE TREES 9, DIRECTION, STREET NAFdE AND CITY <br /> (C) cvairCAL <br /> t �S � <br /> o Cr ' <br /> w <br /> � 1rr ( I < << Lf <br /> ti <br /> city Li <br /> cily C� <br /> Cr <br /> a - ( <br /> CtU AN4 <br /> ct <br /> yoo <br /> Gib/G1 It <br /> l <br /> `� `n 0 u/ c' V <br /> Xj"LAI jzv cir L( Cc <br /> cjty <br /> Page of <br /> tH7f13 4 SEPTAGE CLEANERS REPORT <br />