Laserfiche WebLink
SAI JCAQUIN CC>UNTt' <br /> x EN11R014MW[AL HEALTH DEPARFOU Return this form by the <br /> 1868 EaS1Hazelt0 Av.nue, Stockton,C,�95'.�5-6232 12th of each month <br /> ka Telephone:(2M4i8-342GFax.,(209)464-0938 Vreb:o-,Av,sjgov.-)r�eh <br /> 3EPTAGE CLEANER'S REPOF. <br /> Company Name: 0. C� Repor�br:tem n af: year <br /> I p <br /> 4� <br /> Company Address: igna`. <br /> StreMAao s :iG' Tip 'rte �� <br /> All Information submlttid must be Complete, accura-( .nd legible <br /> DATE NAME OF SLIVESS OR hD)R[SS WHEHE WORK WAS DONE GLUAg (R) RFS1DEtfnt,L NAME OF TREATMENT <br /> PUMPED PROPERTY)WNER t169,ED (G) GREASETRAP FACILITY <br /> PLEASE INCL D STREST A, DltEcrion, STREET NA'LE i13 CITY CI CHEPACAL <br /> Sf17Ss l� �,r c: U�'SL <br /> r-jty 10 <br /> �i r✓P (r <br /> Gityc ' L c Lt <br /> c- <br /> c, <br /> cit <br /> 0 <br /> City <br /> c. <br /> CRY <br /> CIN0 <br /> cityr` <br /> City <br /> -RECENEa- I_ <br /> Gi <br /> Cit' <br /> Page of <br /> JUN 0 7 2017 <br /> 42 AS tNVIRONMENTAL NEAl.TFI SEPTAGE CLEAWERS.ZUORT <br /> PERMIT/SERVFCES <br /> :ti%%E�vN <br />