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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Return this form by the <br /> INA 16r ` 1868 East Hazelton Avenue, Stockton, CA 95205-6232 121h of each month <br /> t�jr Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ii SEPTAG_hE CLEANER'Sf ` � �R"EPORT <br /> Company Name: y� I (ir4x- ) i n G �Gr c&-" Cd L-) Report for the month of: r I 1 year U� <br /> Company Address: S« r) H Q-k-C CSignature: <br /> Street Address City Zip Code <br /> All information submitted must be complete, accurate, and legible <br /> DATE NAME OF BUSINESS OR (R) RESIDENTIAL <br /> ADDRESS WHERE WORK WAS DONE GALLONS NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER PUMPED (G) GREASE TRAP FACILITY <br /> PLEASE INCLUDE STREET #, DIRECTION, STREET NAME AND CITY C CHEMICAL <br /> C cit ����f✓/ XIL <br /> Cit <br /> Cit <br /> Cit <br /> Cit <br /> LO <br /> Cit <br /> MAY e 2Qi <br /> Cit <br /> City EN IRQ <br /> Cit <br /> Cit <br /> Cit <br /> CII <br /> CII <br /> Cit <br /> CII <br /> Cit <br /> Cit <br /> city <br /> CII <br /> EHD 42-04 SEPTAGE CLEANERS REPORT <br /> 10/4/07 <br />