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RECEIVED .�::• <br /> 0 <br /> SEP 18 20;y <br /> K" SAN JOAQUIN COUNTY ENVIRONME <br /> ENVIRONMENTAL HEALTH DEPARTMENT PERMI I ,.J%M(lrif`this form by the <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 12'hof each month <br /> ra <br /> C/DTelephone. (209)468-3420 Fax:(209)464-0138 Web:wvvw,sjgov.org/ehd c <br /> SEPTAGE CLEANER'S REPORT <br /> Company Name: c'-' kFs -kwoFt UtCa- Report for the month of: year 1CD <br /> 0 <br /> Company Address: 1.. Vt'to Sig c. <br /> Street AA dress City Zip Code n <br /> CD <br /> N <br /> All information submitted must be complete, accurate and legible <br /> 1- DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS (R) REStMNTIAL NAME OF TREATMENT <br /> i�-- PUMPED PROPERTY OWNER PUMPED (G) GREASETRAP FACILITY <br /> PLEASE INCLUDE STREET N, DIRECTION, STREET NAME AND CITY C CHEMICAL <br /> `1b 17/0 D344twif* —70 C Iry <br /> Cit CID <br /> !0�✓ `7 a <br /> N - <br /> `l 1 a N /o i 64w4 city F/0 -70 <br /> ►` ACJ /7/0 64dl 71YVW,,4 city j55-M/a `70 <br /> 00 <br /> g t� •,F,eu�o^� <br /> 7 c . �A G c�4/o�•1 `70 G IL '`l � <br /> Co�Sf row+ <br /> ye lr /D 1AW^iO city <br /> �3 �� .�9�►+ f�o^s v ��o Cirf ryro c erc.4-40�✓ <br /> 0 <br /> city <br /> Cit C!! <br /> rQ <br /> Cit o <br /> A <br /> city <br /> W <br /> Cityo <br /> cr <br /> city <br /> citv <br /> �s <br /> 0 <br /> Cit N <br /> W <br /> city <br /> Page of - o <br /> 0 <br /> EHD 42-04 SEPTAGE CLEANERS REPORT p <br /> 12/27/13 <br />