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SAN JOA4 UIN COUNTY <br /> ,ENVIRONMIJTA1,1-1 EA LTI-I UEPAR"fA'IE:1V'f Return this fOt'ul by <br /> _' : 304 East Weber Avenue.3rd Floor, Stockton,CA 95202-2708 � the 12"' of Ctleh t110l1t11 <br /> "•, y j1 _'' Telephumn,(209)468-3420 Frit;(209)464-0138 Web: kv%vw.sjgov.org/ehdit\� `J/1j <br /> Q "Y SEPTAGE CLEANERS REPORT <br /> Company Dame: _ dti S'C ' `� TV�(I-P-- Report for the month of.- year <br /> ConlpnnyAddress: _-3,4a. ,t.]. etN-t'r a i (yy—j Z.Skvj ! gS3Signature: <br /> SImv,Addres C,ly Zip Code <br /> All inf)rmatiat] submitted mnyl he cam iete, accurate ind Ir ible <br /> OD <br /> m (It} nt smt�TI.,L <br /> DATE NAME OF illlSINBS OR ADDRESS WHERE WORK WAS DONE GALLONS {G1 GREASE-TRAP NAME OF TREATMENT <br /> pp MINIP6.I? PROPERTY OWNER P L F.A S E I N C L U 0 r, S TR E E T k, U 1 it k:u'r 1 o N,, s T R E E r Y,l m E AX 0 C 17'1' PUMPED G ciieytiGA]. !ACIL17 Y <br /> r <br /> 0 City <br /> N <br /> City <br /> Cit) <br /> City <br /> City <br /> City <br /> city, <br /> Cil• <br /> City <br /> C ily <br /> cav <br /> U <br /> Q r�Sly <br /> tv <br /> Cit}. <br /> City <br /> Q <br /> City <br /> (LS Crly <br /> nD <br /> dj Cliv <br /> O <br /> O <br /> In <br /> Ciiy <br /> tii fU d?�I]•il�5d ScµudCrvsµi.wl krpwl <br /> H:UL^Ilpd <br />