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RECEIV,wL1-- <br /> NOV <br /> 09 2 <br /> SAN JOAQUIN COUNTY <br /> �r ENVIRONMENTAL HEALTH DEPARTMENT ENVIRON Return this form by the <br /> 9868 East Hazelton Avenue, Stocldon, CA 95205-6232 pERMM SNTAL HEA " �2th of each month <br /> Telephone:(209)468-3420 Fax:(209)464-0938 Web:%vww.sjgov,org/ehd ER+IICEc <br /> SEPTAGE CLEANER'S REPORT <br /> Company Name: Report fortAA r <br /> Company Address_ .3�S'.gnatur - r <br /> Street Ariss City Zip Code �} <br /> All inforrnatlon Submitted mast be complete, accurate, and legible <br /> DATE NAME OF allSINESS OR ADDRESS YJH ERE WORK WAS DONE GALLONS (R) Rcsloerrrut NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER PUMPED (G) GREASETRAP FACIL[TY <br /> PLEASE INCLUDE STREET k, DIRECTION STREET NAME AND CITY C} CNEL11CAL <br /> CRY Ll�r <br /> l lQ- Cit? <br /> Cit• c u u <br /> It ("ZZ 4 7 <br /> Cit, <br /> Lo -. 13 Cir o cc_ LC <br /> 1 <br /> C414 <br /> CD. <br /> City <br /> cityQ <br /> city <br /> cit <br /> 0 <br /> City c� <br /> CRY6; <br /> Cfty <br /> z <br /> C. <br /> a <br /> E_ <br /> Page of <br /> EH SEPTAGE CLEANERS REPORT a <br /> 12127/13113 � <br /> ■ <br /> 0 ■ ■ ■ <br />