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Qr,.auln' SAN JOAQUIN COUNTY <br /> av-•.oti <br /> z r ENVIRONMENTAL HEALTH DEPARTMENT Return this form by the <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-623212tH of each month <br /> 4<«�,��';*• Telephone: (209)468-3420 Fax:(209) 464-0138 Web:www.sjgov.org/ehd <br /> SEPTAGE CLEANER'S REPORT <br /> n <br /> Company Name: a�„ C U- Report for the month otdgwaqlz year j <br /> Company Address: ��.3 ��ji=G; C., 5 � / <br /> Td �4 I� 3Signature: �illGy �/L/�'�./ ✓ <br /> Street Address City Zip Code <br /> All information submitted must be complete, accurate, and legible <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS (R) RESIDENTIAL NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER PUMPED (G) GREASETRAP FACILITY <br /> PLEASE INCLUDE STREET #, DIRECTION, STREET NAME AND CITY (C) CHEMICAL <br /> s E —eh F,610 CAi"ll 67 Cu <br /> P-av,✓l�-[6�os /v a r' � fig,+/ city 5722 If AL v <br /> IR <br /> L � City E7d—C ^ oS <br /> cite J r r <br /> Cit �!7L <br /> /f 32,113 Cit .1/U(?IC/ O/✓ 5vd r t �� <br /> 14 #Mi c P, W,'C styd Cit <br /> -A/- !f i��l,n, a/�Ja �r/p r�i,� e �G Cit <br /> Cit <br /> C ���Alzw)t 0#-IVC4 City 1SZL <br /> ZA .2 Ijh/6z4-:vCit S <br /> / <br /> 5914 32/S / //"/ �. Cit <br /> cit J �/V <br /> �ZZC (Q minlel c v 4j 11A4�— city S5M72 V 3Uv J _� <br /> 32,t'/3 lei/ I�,7be Mw,,6 City <br /> o��/ 8t�t��fit irl/ l� ii✓� r, Cit Sic" l-ZI l SUtT I i <br /> z-*w. <br /> Cit <br /> Page •9. of�.;] <br /> EHD 42-04 <br /> SEPTAGE CLEANERS REPORT <br /> 12/27/13/13 <br />