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�oP" SAN JOAQUIN COUNTY <br /> i• <br /> ENVIRONMENTAL HF'%TH DEPARTMENT turn this'X; b <br /> m D 600 East Main Street, S Jon,CA 95202-2708 RECEIV 12's of h tuonth <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.Org/ehd <br /> P <br /> CHEMICAL TOILET CLEANERS REPORT DEC 2 9 [011 <br /> Company Name: _ ✓ ��os Report for&IMMekAUj4Eyear <br /> Company Address: Signature: PERMIT/SERVICES <br /> street Address City Zip Code <br /> All information submitted must be complete, accurate, and legible <br /> TOTAL NUMBER OF TOTAL VOLUME OF <br /> DATE CITY WHERE PUMPED CHEMICAL CHEMICAL TOILETS CHEMICAL TOILET WASTE NAME OF TREATMENT FACILITY <br /> PUMPED TOILETS ARE LOCATED PUMPED IN SPECIFIED WHERE CHEMICAL TOILET WASTE DISPOSED <br /> �f CITY PER DATE PUMPED PER CITY PER DATE - <br /> !0 '/1p-11 � <br /> — /06 — 1LJ <br /> /D /lo-!! Dae+G /lrt/ .4-6 <br /> /6-16-11 v-w 56 v-w K-sl <br /> 16 /lam-// -10 q0 e- <br /> 16 -110-11 <br /> 1D -110-11 v-10 60 k-a2 <br /> /0 'Zo~1IZO& 120 �la�se <br /> /10 'ZO-1I KI"A J Sob /61L-Ka 10-4d <br /> AIAI <br /> S6 il-4d <br /> 1''S"ll v -w 14 -3F v -w <br /> {I l511 V-10 <br /> 1-15- 11 V-u) 40 2T v-� <br /> 11 i !I L 50 <br /> C61az1Lrdmms - 7 <br /> /1•l5'{Iv-10 1/ /u C <br /> 11 2D elAR, <br /> AAa- �laD 14A1 <br /> /l to l/ � 2LZ) yEeWe 6..J' <br /> !1 pp l/ f7,ucl�l - 2dIU - 44 W <br /> 3t Ue ZID2 <br /> EHD 42-017 <br /> Chemical Toilet Repan <br /> 9/232004 <br />