Laserfiche WebLink
RECEIVED <br /> pRKln, <br /> JUL d 0 2017 SAN JOAQUtN COUNTY <br /> EfAI RONMENTAL HEALTH DEPARTMENT <br /> {' ENVIRONMENTAL HEALTH 188E East Hazelton Avenue, Stockton CA 95205-0232 RatUrn this form by the <br /> PERMIT/SERVICES Telephone:(209)488-3420 Fax:(209)464-0138 Web:www.Sjgov.orglehd 12 of each month <br /> IdIA7 /rt' PTA E CLEANER'S REPQRT <br /> Company Name: �<J )1111 <br /> Company Address; Report for the r o th of: year <br /> SireetAddress Cfty Signature- <br /> Ali Information submitted must be com fete, accurate, and legible <br /> Zip Code <br /> DATE I4AME OF BUS11Jr=SS OR <br /> PUMPED PROPERTY OWNER ADDRESS WHERE WORK WAS DONE GALLOtdS (R) RESIDEM1TRAL <br /> PLEASE fNCLUD STREET p, DfRECTID}I, STREET NA61E AND ctTY PUMPED (G) GRrASETP.AP NAMEFACILMY <br /> TMENT <br /> � U C cicEa�icaL FACILIT <br /> � <br /> C1 <br /> �.j/V <br /> / �LJ City q i( <br /> 1 Q <br /> o?�t c•, Gi ! 6 Ov 1-A, Y <br /> Cit C ( OU <br /> oDo <br /> C( C9too <br /> ! ; o <br /> c' C.( <br /> Q <br /> c <br /> 0 <br /> c <br /> c� o <br /> G- <br /> city <br /> Q <br /> Page of — <br /> EHD 42-D4 <br /> 72127!93 a, <br /> SEPTAGE GLEANERS REPDRT <br /> ■ <br />