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RECEIVED <br /> CD r SAN JOAQUIN COUNTY <br /> SPR 2016 ENVlRO1�MEIJTAL HEALTH DEPARTMENT Return this form by the <br /> fi00 East Main Stre=et, Sfflckton, CA 95202-3029 12' of each month <br /> w ENVIRONMEN I-ALTifttWne:(209)46B-3420 Fax.(209)464-0138 Web:www.sjgov.org/ehd <br /> <1 PERMIT/SERVICES <br /> _ SEPTAGE CLEANER'S REPORT <br /> Company Marne: 3 �Lu C Report for the month of-. / '� � ear aD lei <br /> Company Address: EC- ' 25C2 x C2 ���S �� �'�� �� Signature° 2f—aL/6;74l <br /> StraA Address Y Zip :ode <br /> AEI i.ntormatinn submitted must be complete, accurate, and ie ibte <br /> I ADDRESS WHERE'WORK WAS DONE GALLONS � ��D�'L NAME OF TREATMENT <br /> EM <br /> !; oATE NAME OF BUSINESS OR PUh1PE[T �G) GREASETRA? FACILITY <br /> I JFjiPED PROPERTY OWNER PLEASE 114CLUDE STREET If, DIRECTION, STREET NAISE AND CITY C CEi£1,1[CAL <br /> LEcityW <br /> LdL <br /> <-I <br /> F- a ty <br /> co <br /> ILl <br /> { <br /> city <br /> Uri <br /> W G rLy <br /> <L <br /> } C <br /> cay <br /> c <br /> C <br /> r� <br /> .o <br /> C- <br /> city <br /> v 1, <br /> CD city <br /> Ln cay <br /> co <br /> mCi <br /> �y o <br /> c� <br /> city <br /> 06 <br /> `7 <br /> city <br /> L0 <br /> C� <br /> city <br /> m <br /> a� <br /> c� City E= <br /> 04 m c- <br /> CD <br /> SFPTAGE CLEANERS REPORT a, <br /> EHD 42-04 <br /> 1914107 <br />■ <br /> ■■ ■ ■ ■■ ■ ■ ■ <br />