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sseitf, c SAR JOAQUIN';D©HTY <br /> o •ate <br /> ENVIRONMENTAL HEAM DEPARTAENT Return this form ],y the <br /> _ 1368 East Hazelton Avenue, SwIlon, CA95205-6232 12'' of each mon*-h <br /> Telephone (209)468-3420 Fax: (209)433P)13B Web:wwwstgov_orglehd <br /> SEPTAGE CLEANER'S REPORT <br /> Company Name: ` Report for the h ON year— S <br /> Company Address: 3a Signature: <br /> Stmet F'sdws C4 Z"Code <br /> Alt Information submitted must be complete, accurate, and le able <br /> (R) RESIDENTIAL NAIVE OF TREATMENT <br /> DATE NAME OF$USIIJ ESSOR ADDRESS WHERE WORK WAS)CNE GALLON (G) GREASE TRAP <br /> PUMPED PROPERTY OWNER JP. PUMPED FACILITY <br /> PLEASE IHCC E STREET , DIRECTION. MEET kH0 CITY C} CHEMICAL <br /> D <br /> S b <br /> t ;it <br /> �lrr a <br /> car � <br /> crrLi <br /> c' <br /> Lr, <br /> CW o <br /> 13 20 <br /> m <br /> E VIRO <br /> RMITjSE,'L HE A L771ivicro <br /> �I <br /> Page of <br /> EHD 42-04 SEPTAGE CtEA14ERS REPORT — <br /> 12f27/13 a <br /> E■ ■ ■ ■■ <br />