Laserfiche WebLink
RECEIVED <br /> atq s JUN 201 SAN JaAQUIN COUNTY <br /> Cut- <br /> . . E IVIRONIAENTAL HEALTH DEPARTMENT Return this form by the <br /> ENVIRQWMENTAL HEALTH 1 868 East Hazelton Avenue, Stockton CA 95205-6232 12u'of each month <br /> PERMIPSERVICES Telephone:(209)468-3420 Fax:(209)464-0138 Web:vNm.sjgovorglehd <br /> r+sin <br /> SEPTAGE CL EAMER'S REPORT <br /> Company Name: Report for t m n of: ar <br /> Company Address: Signature: ti <br /> Stinm Adpress Cit)' Zip Code <br /> All Information submitted must be complete, accurate and legible <br /> DATE NAME OF BUS114ESS OR ADDRESS WHERE WORK WAS DONE GALLOXS {a) RESIDENTIAL NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER PUMPED {G} GREASETRAP FACILITY <br /> PLEASE INCLUDE STREET ff, D ECTICN STREET NAME Arta C17Y {C} CIiEk11CAL <br /> c /S ab l <br /> s � i J <br /> cit �; — n <br /> �} �t <br /> city v� Lt q <br /> L ( - 6- e� 0 ) 1--j /�/ �Q�� — Cit. <br /> Cit' <br /> city o <br /> 0 <br /> city <br /> city a <br /> city C-4 <br /> Cil' <br /> 0 <br /> citC-, <br /> Cii m <br /> Cil � <br /> l <br /> city <br /> Page of <br /> EHD 12)'2�YI3� SEPTAGE CLEAAIERS REPORT <br />■ ■ ■ ■ ■ <br /> ■ ■ ■ ■ ■ <br />