Laserfiche WebLink
�4utn, SAN JOAQUIN COUNTY <br /> � �ra�ati <br /> z ENVIRONMENTAL HEALTH DEPARTMENT 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 /> lSE/P�TAGE CLEANER'S REPORT ,1 <br /> Company Name: �'Y/ �/11� - /U (-U- ,� (/PQM Report for the nth of: JC�WVA,F./( year_a <br /> Company Address: M p Signature: <br /> Street Address ity 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 WR—E—A S—E TTRAID FACILITY <br /> PLEASE INCLUDE STREET #, DIRECTION, STREET NAME AND CITY ( CHEMICAL <br /> cit �/U )% d G1 ' <br /> G'#4F)4ty/ AmIlk— City wz - <br /> IIS172-- city �/ DOCS <br /> 1' �0✓✓✓L l' s n y'� 1/Y�i��T^ Cit , I 0U <br /> o�� i✓C• /3/0 zu <br /> uS�iniTE 4'Vk� cit z <br /> s �y� !��✓ Q.;3 A;�r ��cmi�'� .Ql�� cit <br /> va !/l/- U& ,�l-ic= - //!/g- cit <br /> city <br /> A3 1V0 #C4r, ���14� City <br /> xTO nv / <br /> /dr/V <br /> / '7,� Al XAIA vs/—. Cit Ir - <br /> '� 4130 ,Vc)/llWU411 1i/k[4 cit 1( 5 <br /> LIq cit <br /> G✓yST�i Tf1Rtl /'�'�� >Jl <br /> - I .S-/✓1/ G;� 25_A S./ U Cit <br /> eJ ih' city@fC .�UUIJ n <br /> city <br /> cit <br /> ✓ i�f�os -7:5w Cit <br /> Page_ _,of <br /> E D 42-D4 <br /> SEPTAGE CLEANERS F[-PORT <br /> 12//27/1327/13 <br />