Laserfiche WebLink
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 /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> SEPTAGE CLEANER'S REPORT <br /> Company Name: �Gtx r-t, ri0 60 a� Report for the month of: year <br /> Company Address: )� U 02.3 5Ck.1w-\ R ck�c CAA44463 Signature: <br /> Street Addres City Zip Code <br /> All information submitted must be co m lets 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) GREASETRAP FACILITY <br /> PLEASE INCLUDE STREET S, DIRECTION, STREET NAME AND CITY C CHEMICAL <br /> j I <br /> j ci-,111w,"w," b < - C` _ r i t ,1 .�5 i) ]OCL- ' i <br /> r C �� cit 7"Y)� <br /> City <br /> Cit <br /> i Cit <br /> *` Cit <br /> Cit <br /> City <br /> j Cit <br /> Cit <br /> Cit l <br /> Cit <br /> Cit <br /> Cit <br /> Cit <br /> city <br /> Cit <br /> Cil <br /> Cit <br /> EHD 42.04 SEPTAGE CLEANERS REPORT <br /> 10/4/07 <br />