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SAN JOAQTAN COUNTY <br /> fl EwIROM ENTAL,HEALTH DEPARnffi-NT Return this form by <br /> 304 East Weber Avenue,3d Moor,Stockton,CA 95202-2708 the 12"of each month <br /> fl Telephone. (209)468-3420 Fax:(209)464-4138 Ti eb;www.sigov.orglehd <br /> D o SEPTAGE CLEANERA''S "PORT <br /> IL J Company Name: Report for the month of: pear <br /> Company Address: f.�a� - S Signature: <br /> SYrtel Addres% City Zip Code <br /> All information submitted must be com lett, arcuralc, mad legible <br /> l�`� RLfi1DEKIlAI. <br /> DATE t\AMF OR BUSINESS OR ADDRESS MUM NVORK WAS DONE GALUONS (C) cRaASE Tlu� NAME OF TREATMENT <br /> PIPED PROPERTY ONVP R PLEASE INCLUDE STREET n. DIRECTION, 8T/REST NAME AND CITY PUMPED (C) CHEMICAL SACHITY <br /> J /./'77 ra h A` "Je S ,r3l /'�XD on <br /> C /A _ #'0'Q -)a//m F City <br /> z .. <br /> T t' �a�u •�It�jLt,fc� 2*V ciw <br /> _77j' ply , <br /> 1JJF <br /> !fit°.!/' a r r i J�• �I/ cp`t� c;n. <br /> csty <br /> if'�.� �^ M�,�f f�,������+ t7�y <br /> / i DSV'')/ j!J '� 1�l?!1 City GY ty' 'moi /'i a.,4e"I�FiLl 1,_ j 0 <br /> 7 <br /> fl I f lam' (, - l� ie'!yc ndlmS City <br /> City <br /> n <br /> V <br /> Cit. <br /> n <br /> 9 <br /> Cir• <br /> El9 City <br /> V <br /> v Citi <br /> V <br /> n EHD 42-04 <br /> 8/30104 _NVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br />