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1 I. <br /> 3a <br /> San Joaquin County Environmental Health Division <br /> Septic Wank and Cesspool Cleaners Report t, <br /> Company's Name: SRC Pumping Co. <br /> Company's Address: 11350 Kiefer Blvd,Sacramento, Ct, 95830 n <br /> �f <br /> Report for the Month Of. 1:7". ad � <br /> Gallons Where Cleanings <br /> O <br /> Date Name ofPropertPOtvner � Location Cit <br /> ' -- E :Pumped Were Unloaded <br /> e�l <br /> 0 E �DJ e <br /> �' 1��`G' i9►1� /� �- it r l <br /> 3 &21 <br /> �— <br /> o,6 vii <br /> f� Return by the 12th of each month to: <br /> Date Signature of Applicant Environmental Health Division <br /> 304E. Weber St., 3rd Floor <br /> Stockton, Ca. 9.5202 <br />