Laserfiche WebLink
RECEIVED <br /> DEC 10 2015 <br /> of;�w <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT ENVIRONMENTAL HEALr_.Return this form by the <br /> PERMIT,SERVICES1868 East HazeilonAvenr�e, Stoci;(on, GA 9520 -6232 � 12 of each fttonth <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:vmv.sjgo%r.org/ehd <br /> SEPTAGE CLEANER'S REPORT <br /> Company Name: � Report for the ttl of: yearo2d <br /> -- - <br /> Company Address: Signatur <br /> Street AcLKriTs Cit Zip Code <br /> All information submitted roust be complete, accurate, and legible <br /> DATE NAh1E OF 6USINESS OR (R} RESIDENTIAL <br /> ADDRESS WHERE WORK WAS DONE GALLONS MA61E OF TREATTsSENT <br /> PUNMED PROPERTY OWNER PUMPED (G) GREASETPAP FACILITY <br /> PLEASE INCLUDE STREET k, DIRECTION! STREET NAME AND CITY (C} CHEFACAL <br /> City <br /> C!t ( u <br /> -f 41, <br /> - ems' c <br /> o rs� CA- <br /> K <br /> 0 <br /> f 3 c / (,c <br /> Ld — 4 <br /> OCDCity <br /> City <br /> 0 <br /> ca j <br /> C' <br /> � v <br /> cF' <br /> D <br /> C.ty <br /> a <br /> Ci � F- <br /> -a <br /> Page Df <br /> EF{D 42-04 SEPTAGE CLEA14ERS REPORT <br /> 12J27113 <br />■ ■ 0 0 ■ <br />