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aG <br /> San Joaquin County Environmental Health Division <br /> Septic Tank and Cesspool Cleaners Report <br /> Company's Name: SRC Pumping Co. <br /> Company's Address: 11350 Kiefer Blvd,Sacramento, Ca. 95830 <br /> Report for the Month Of. /v�Cr/ <br /> DateOGallons Where Cleanings <br /> Name o Pro ert wner Location ON Pum ed Were Unloaded <br /> 77N CJu <br /> T7 r <br /> 1 �f1 <br /> /06 �.°1/ <br /> /a r <br /> � J - <br /> / Y <br /> Return by the 12th of each month to: <br /> Date Signature of Applicant Environmental Health Division <br /> 304E. WeberSt., 3rd Floor <br /> Stockton, Ca. 95202 <br />