Laserfiche WebLink
apgKtr�„� SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Return this form the <br /> x 1868 East Hazeiton Avenue, Stockton,CA 95205-6232 'i 2�'of each month <br /> Telephone:(209)468-3420 Fax:(249)4544138 Web:vvww.sjgov.org/ehd <br /> Etr;�,stt ' <br /> EPTAGE CLEANER'S REPORT <br /> Company Name: td f Report for the m of: years u <br /> S'CamNany Address: ` a r nature <br /> Street Address City Zip Codes <br /> All Information submitted must be complete, accurate, and le Ible (R)- RESIDENnU <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS (G) GREASE TRAP NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER PUMPED FACILITY <br /> PLEASE INCLUO STR E7 K l)IRECTIGN. S7REET ,1AA1E AND CITY ( <br /> C CHEItICAI <br /> O <br /> 0 fd �L(c 6 rpt <br /> city <br /> cily <br /> f < U �` <br /> 3�� `` <br /> v <br /> f �✓ C L �G` V I L' `c o <br /> Cit o <br /> —o 6 << <br /> Q <br /> Ch <br /> A 00 <br /> J Ct'tcity <br /> C ct `r <br /> city <br /> CR <br /> Page of '— <br /> SEPTAGE CLEANERS REPORT — <br /> EVD 42-04 <br /> 12127113 - <br />