Laserfiche WebLink
ILI <br /> l i4D <br /> ENVIRON-i`]E\TM' HEAL-fiq DEPARTMEN-1 Return this form by <br /> 304 East Weber Avenue, aid Floor, Stockton,CA 95202-2709 the 12th of each month � <br /> 1 Telephone:(209)468-3420 Fax:(?t?9)464-013 8 Web:vvww.sigov.org.'ehd m <br /> w <br /> CHEMICAL TOILET CLEANERS REPORT I� <br /> Company Name: 1 m ' A C- Report for th Monti!of:_ •ear <br /> Company Address: e2 <br /> w, i 5ignatu€re _•' _.._C �,�_� — <br /> Ssee�Address Cin Zip(.gde <br /> All information submitted must be com €C#e, accurate, and lepib€c Q <br /> TOTAL NUMBER OF TOTAL VOLUME OF3 <br /> DATE CITY"WHERE PI.:.NIPED CHEMICAL ' CIZEMICAL TOILETS CHEMICAL TOILET WASTE -NAME OF TREATMENT FACILITY 1� <br /> PC11'fl'I;D � TOILETS ARE LOCATED � P[:1IPFD IN SPECIFIED WHERE CHEMICAL TOILET WASTE DISPOSED <br /> CITY PER DATI PI:1IPED PER CITY PER DATE � <br /> I <br /> I H <br /> _ 1 l.1 S <br /> Ln <br /> I 21 ]J. <br /> i <br /> 2.- <br /> S 6 C4cn <br /> cn <br /> 00 <br /> tkc <br /> ! I m <br /> z Z) <br /> i <br /> MD <br /> Eli <br /> .. yC11 - - <br /> � yyk Ln <br />