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t <br /> San Joaquin County Environmental Health Division <br /> ai Septic Tank and Cesspool Cleaners Report <br /> r <br /> Company's Name: d <br /> SRC Pumping Co. , <br /> Colnpany's Address: 11350 Kiefer Blvd,Sacramento, Ca. 95830 <br /> Report far the Month of. <br /> �3. <br /> Date Gallons Where Cleanings <br /> Name o Pro ert Owner Location C� Pum ed Were Unloaded <br /> it <br /> /a?vme <br /> /? fJ <br /> ,�G �' it <br /> w <br /> _ <br /> A <br /> � v •cS �� �O / G �1� �t /1 <br /> i <br /> i <br /> l - <br /> Return"by the 12th of each month to: <br /> Date Signature of Applicant Environmental Health Division <br /> 304 E.'Weber St.,31d Floor <br /> " Stockton,Ca. 95202 <br />