Laserfiche WebLink
a",Rultt. <br /> y- aW °� SAN JOAQUIN COUNTY <br /> L ENVIRONMENTAL HEALTH DEPARTMENT <br /> Return this form by the <br /> +-. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 12t" of each month <br /> "+ Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> SEPTAGE CLEANER'S REPORT <br /> Company Name: ,�� /�f i, z'2 lw' 'ke Report for the h of: year <br /> Company Address: Signature: <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 GREASETRAP FACILITY <br /> PLEASE INCLUDE STREET #, DIRECTION, STREET NAME AND CITY CHEMICA <br /> 49 �'m city <br /> City. <br /> ,L/ l� Cit <br /> 11.3 Cit <br /> a 171 er�� �� � Cit ll� <br /> -rid - Z / Jv A9 r24 n,,'7 Dfi• Cit <br /> Cit 1 <br /> a3 1 M, a L 7 W.'4FS�S� i Cit <br /> Cit <br /> �� � CE s� � Cit <br /> -50 <br /> �n o Gtf Ci <br /> S- J Cit <br /> S 3 o- 4 n ' h'�`O�' City �I <br /> FL �20 - <br /> cit <br /> rte' ill " 5c lo'. cit /avD <br /> Page _of 5 <br /> END 42-04 <br /> 12/27/13 SEPTAGE CLEANERS REPORT <br />