Laserfiche WebLink
Qr,,4tul?y <br /> SAN JOAQUIN COUNTY <br /> ' 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: Report for the th ofyear <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 GREASE TRAP FACILITY <br /> PLEASE INCLUDE STREET #, DIRECTION, STREET NAME AND CITY CJ CHEMICAL <br /> city / <br /> city L) <br /> Box r !i City O'd <br /> Cit <br /> �a .✓�e n/—/ �8� �� / i Cit <br /> IT/`G� cit 9 I <br /> - -Va l 6u/7 jv/ aZ //v, 17W?-1-1,0WkCity it <br /> &AoAlt SZ cit U <br /> Ci I I l�l <br /> zl✓ '4 cit UPJ <br /> Cit <br /> D 2TNi . �<9�1fCLt/ <br /> city9l SU <br /> 32 15— city <br /> av 4— ,6- � -Z) A*ATe I Cit I ' J <br /> / City / ( , 5?,fd <br /> a oLid XD• Cit !I <br /> / ���: Di�✓l �� Cit /I <br /> 511 O <br /> Page of-" - <br /> EHD 42-04 <br /> 12/27/13 SEPTAGE CLEANERS REPORT <br />