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SAN JOAQUIN COUNTY <br /> ENwR®NMEwAL HEALTH DePARTwEiv " Return this farm by the <br /> 1068 Fast Hazelton Avenue, Stockton, CA 95206'-6232 12th Of each month <br /> Telephone, (209)468-3420 mix;(209)464-0138 Web:wwwrsJgov prq/and <br /> L, r <br /> SEPTAQE CLEANER'S REP'oirr <br /> QL,ompany Name: t5 mo C) Report for the month of: _14_431b 1 year,a ,,,�; <br /> o<<>ompany Address: v-) C) � C 8lgnature:`��' <br /> Stlnet Addlnn5 City Z p Cods <br /> N InVnrmatlon oubmitted�l usk be aam�letm,_ aoourrelpm�, �.nd to .i•bla __ :� <br /> -.....__........__�•---•...:.^-ram:^. -sz.•,_,_,._�:_.._...`___- —•wrs:-.r_.us _..,._..: am...r-.nom=I- a_ •arr.:a�.�•re.:crr=:x:s_-s�=:e.-=r,-.-r...naaroas.:u-..:zc-�•c.:...---�.:r ..-�,.c;,�,.r�..ti'=.x.. mcsartrc ..__ <br /> ~~ DATE NAME OF BUSINESS OR VADDRESS WHERE WORK WAS DONS GALLONS (R) ACOIDONTIAL NAME OF TREATMCNT � <br /> PUMPE=D PROPERTY OWNER PUMPED (C) awsE TRAP FACILITY <br /> I_ PLEASE+ INdI.UDC ll <br /> STREET , UIREOTION, STRUMT NAMM AND OITY /C dN8 0 L <br /> =:c:-�rr_..rx::c:c.,--�;,-r�.^rr_arc•�•_•.-•�.���a•�=•..:scams..... ���.-•�a:�c•�•:.....,,..��.....__........_,.�-y�^•---^•-'-^--.:.rr_r._._4.—�..=..-�.�•t.�==x.`::�-=.tt:•� -^__._--«r•�-�-r 1-.�.^.-��.�__._.._....xtirsc,_c..;�__....._....-•x:n� <br /> 1 _. �.._ .._. Lill ......._. .,.._. ... <br /> afi <br /> R!l <br /> Com_ <br /> Cit <br /> all +•V'R0 <br /> a!t TiSFR HEAL? <br /> ca l <br /> Cit j <br /> otty dl, <br /> CR <br /> Ct <br /> CI ;Clt fl`` <br /> �I <br /> Ct TI <br /> 1t <br /> � .�Y:-.':.'G�.._'Y��.�..���-��=ALF_�•CYff•.`J•2�.L.�r.�.�^��GtA7r, ...,�•.'`Y'.4T' '_:cS_....�].c�C_i�.�...�.�-�^.+"':�fL�S"��^..t��3'.�����_....1:5•�'�.ti.. r<.:a _ ^�St�]a�b'C�.�.�_."__�."..k��4t^"=C•�A:'.�.._..�-....-+ a i� -':..' <br /> Q 1 1�1 > Wyk'WD 42-04 w� SEP7AO!~Cl.FANER9 REPRf7T <br />