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RECEIVED <br /> MAR 0 2 2016 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT ENVIRONMENTAL H Return this form by the <br /> �= HEALTH . <br /> •=ti 1868 East Hazelton Avenue, Stockton, CA 95205-5232 PERMIT/SERVICES '12uof each month <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:wtuvr.sjgov.oig/ehd <br /> SEPT GE CLEANER`S REPORT <br /> company Name: Report fort a nth of: y ati.26 I k---, <br /> Company Address: <br /> Street drew C Signature: <br /> Zip Co3� <br /> All Information submitted must be complete, accurate and legible <br /> DA E NAME OF BUS114ESS OR ADDRESS WHERE WORK WAS DONE GALLONS {R) RESIDENTDtiL NAME OF TREATMENT <br /> PUit9PiiD PROPERTY OWNER PUMPED (G' oRFAsFTruQ FACILITY <br /> PLEASE IRCLUDE STREET @, DIRECTION, STREET NAME AND CITY C CM CAL <br /> Ctt <br /> t t� Lk <br /> C4 C l € <br /> ci <br /> cit- <br /> Cit- <br /> y <br /> -/ 6 - <br /> -5 cityK p 4 k <br /> City <br /> t <br /> City <br /> a <br /> City `" <br /> t <br /> C' <br /> C � <br /> t <br /> c.ty <br /> a' <br /> --T <br /> E <br /> C ~ <br /> Page of a <br /> EHD 42-04 N <br /> 12/27/13 SEPTAGE CLEANERS REPORT N <br />