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------------ <br /> {• _ .. _ . � _ . �; �. ..- - } /ate �.v , <br /> San Joaquin County Environmental Health Division - <br /> Septic Tank and Cesspool Cleaners Report A 5 0 g <br /> . ENVIRONMENTH ALTti <br /> w. 1_IS <br /> Company's Name:, SRC Pumping Ca. <br /> Company's Address: 11350 Kiefer'Blvd,Sacramento, Ca. 95830 ^•. _ w , <br /> Report for the Month Of. <br /> Gallons Where Cleanings <br /> Date Name o Pro erf Owner Location ,� . .. , . ... Ci , ; Pum ed Were Unloaded <br /> Y 42-7 <br /> LAI U <br /> a; <br /> � _. <br /> Al !/ <br /> " (./Q.� �T .fin/. G� /t • .. .. � � _ � ,/ <br /> ZY <br /> Return by the 12th of each month to; <br /> Date ; Signature ofApptic ant Environmental Health Division <br /> 30,4E. WYeberSt, 3rdFloor <br /> Stockton,Ca. 93202 <br />