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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Return this form by the <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 12th of each month <br /> .011197. Telephone: (209) 468-3420 Fax:(209) 464-0138 Web: www.sjgov.org/ehd <br /> SEPTAGE CLEANER'S REPORT <br /> Company Name: n ,I ) CkLb Report for the /month of: year <br /> Company Address: P. CJ �'� `T�� ignature: X22 t� <br /> Street Address City Zip Code <br /> All information submitted must be complete, accurate, and legible <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS (R) RESIDENTIAL NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER PUMPED (G) GREASE TRAP FACILITY <br /> PLEASE INCLUDE STREET #, DIRECTION, STREET NAME AND CITY 1.� C CHEMICAL <br /> ' LMl�6 � . �� I)LL� car j i 111L�i 1- <br /> cit <br /> Cit <br /> city "Ellice <br /> city <br /> city <br /> 3 2015 <br /> city ENVIRON <br /> MLI tj <br /> cit <br /> FERMI /SERVICES <br /> city <br /> cit <br /> cit <br /> Cit <br /> cit <br /> Cit <br /> cit <br /> cit <br /> Cit <br /> Cit <br /> cit <br /> EHD 42-04 SEPTAGE CLEANERS REPORT <br /> 10/4/07 <br />