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!(SAN JOAQUiN COUNTY RECD OUT 16 zoo <br /> ENV]ItO MENIAL IJLALttl DEPARTMENT return this form by <br /> ., <br /> 304 E Ist 1Vcbr.r Avcn!Ic, i"!FInnC,Stockton,CA 95242-270$ th .12"of each month <br /> Telephone:(209)468-3420 Fria::(209)464-0138 Web:www.sj ov:oENTE <br /> rgleltid � <br /> s�fp• . <br /> rR" SEPTAGE CLEANERS REPORT <br /> Company Name: rC�� �f t 6`C Report for the m0 Ith of:{ 3' -'year Li p <br /> CattlttanyAddress: w _� svt�'. `G .t. cl/ Old,etL `. L5— S1 Signature:OVI . -G -- <br /> Strect Address City I p rode r <br /> All information submitted must be roto tete, necllrate, and legible <br /> IRl ;RFA HN'nAc <br /> DATE NAME OF I3U51NF55 OR ADDRF.&S WHERE WORK WAS DUNK GALLONS (C) (:RL',lSF,TRAP NAME OF TREATMENT <br /> �. <br /> PIIMPFD 1' OPERTYCIWNF,R PIASN INCLUDE STREET N. ARF. <br /> tCT[O:N, STREET NAFF.IAND Cher' PUMPED CHEMICAL FACILITY <br /> 1i' --- — <br /> city <br /> City <br /> City <br /> City <br /> Coy <br /> i <br /> City <br /> ' City <br /> City — - <br /> City <br /> i <br /> City <br /> — i <br /> COY <br /> 0t <br /> .. City <br /> City <br /> co <br /> CD <br /> (D (:i1y <br /> F <br /> U J <br /> � fii!i;4=-V'-11i4 Sctdi UC'cescao!Rrpo! <br /> 8 lti?Icld <br />