Laserfiche WebLink
c SAN JOAQUFN COIX TY ! 9 <br /> b <br /> ED 1,'N'VIR0NXer-.T.'TAL HEALTH DUPARIWffiNT ,`'; p Return this form <br /> by <br /> 600 Fast Main Street,Stockton,CA 95202-2708 <br /> the 12t4 of each month <br /> m <br /> 2016 Telephone:(209)468-3420 Fax (709)464-0138 Web:w%m.sjgov.org/ehd <br /> _ SRPTAGE CLEANER'S REPORT <br /> w RONM��ITAL HEALTH �6" <br /> a a �OPOR PI�iNt;ES Report or them 1, <br /> -� <br /> Company Address: _ Signatu;<� <br /> Sbcu hddictis <br /> CA. Zip Cndt <br /> ,111 lnformalian submitted ❑lust be cum tete, accurate, and le ittle <br /> E, <br /> DATE NAMoruuSINISSOR (R) Rmrnl�TlAt <br /> Al)DAFSS WHERE WORK«'A$DUNE CAL[,41;<S ?\AhiE OF TREATMENT <br /> 3'UAfI'F.0 ruorERTY pWNLR PUMPED (G) cREA5"w FACILTIT <br /> PLEASE IKCLUbC S R6CY a, RIRECTIUN, STRE r KAME AMn CITY (C) CHEWCAL <br /> !�9 IJP — i�lll8 I ` r . Qt`t\1JV ( -0 12, <br /> �- kw -- — - <br /> ��� _� _. 1a��1 N&)N � l� 1 Iwo 6 <br /> 1 M <br /> crt• , <br /> 0 HL lqco I <br /> z ca <br /> WIaEg �5 I ' b U`IvN l rz <br /> u7cw JAL <br /> qq(A Uhw &I CiA m m4w solo <br /> - <br /> city <br /> LO <br /> yo 'a0 G. CheCII <br /> t c�U EZ <br /> 16 -- <br /> 1 <br /> - - <br /> m Cit <br /> m <br /> 5 2016 <br /> On _ F— <br /> tn <br /> Om 0 ' a <br /> (D m PERMIUSEMACES <br /> EHD42-64 <br /> O - -_.. Scy[IsIC'•eagpl K:paR a� <br /> cc <br /> C <br />