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� n <br /> c� <br /> Sall 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.• <br /> DateGallons Where Cleanings <br /> _ Nante ofPronerty Owner Location City Pumped Were Unloaded <br /> 019 ` 4i /6D <br /> J1I%SSi7J /�P�� l/}7i51 <br /> 1/,/v ov� 7 <br /> Sind E NYI. 02 7 uJksi i 7/ Oc'L) <br /> 0 ii i <br /> / 6, Gzz <br /> is i I <br /> d u <br /> d S00 S <br /> it /t J9 <br /> SCS Soul STi+�7 l4 5-ZJl n E t <br /> LOMI <br /> /t til' sit <br /> — / // ✓ LJ� <br /> 1 3P./ e-w-1 <br /> ✓ /a l Return by the 12th of each month to: <br /> Date Signature of Applicant Hnvbvnmental Health Division <br /> lFw - i <br /> Stockton, Co- 95202 OL <br />