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E <br /> San Joaquin County Environmental Health Division <br /> Septic Wank and Cesspool Cleaners Report <br /> Company's Name: SRCPit ping Co. <br /> Company's Address: 11350 Kiefer Blvd,Sacramento, Ca. 95830 <br /> Report for the Month Of.• <br /> Y <br /> + 4i Gallons Where Cleanings <br /> Date Name ofProvertpOwner Location C Pum ed Were Unloaded <br /> Al, ;. sr <br /> az <br /> 53.-? GJ <br /> -Z GU. /YJf'L 2 /l 7d ?r f/ <br /> 9u/1 - e; i GiI, MNA LZ A� r �r �r <br /> 14:- <br /> in <br /> 4: '1 5Uv <br /> f1—o/ F, tel /V rr j <br /> Return by the 12th of each month to: <br /> Date { Signature of Applicant Environmental Health Division <br /> 304 E. Weber St.,3rd Floor <br /> Stockton,Ca, 95.,02 <br /> 1 <br />