Laserfiche WebLink
RECEIVED <br /> Qr,4uf?Y, c <br /> SAN JOAQUIN COUNTY r _ <br /> ENVIRONMENTAL HEALTH DEPARTMENT �P 0 9 2Q1 <br /> 1868 East Hazelton Avenue Stockton, CA 95205-6232 Return this form by the <br /> Tele ENVIRON14ENTAL H IV of each month <br /> phone:(209) 468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd RERMITISER�nC <br /> SEPTAGE CLEANER'S REPORT <br /> Company Name: / �,�i// S'�LJ � � Report for <br /> G`TGl Gf�Si year��'l,� <br /> Company Address: /3 � //.E` .5��'I2 i lZj o., 0vl—'-3C) <br /> Street Address City '� Zip Code Signature: <br /> All information submitted must be complete, accurate, and legible <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS (R) RESIDENTIAL <br /> PUMPED PROPERTY OWNER GREASE T NAME OF TREATMENT <br /> PLEASE INCLUDE STREET t;, DIRECTION, STREET NAME AND CITY PUMPED C FACILITY <br /> CHEMICAL <br /> i XU" <br /> City <br /> v?-3 1 4e6 4u77f M4441/?(J6'0 cit o'�OU17 it I <br /> •j� fZ AI T I l lU Cl/Fr�i TT�i /V� <br /> CityIr ja <br /> 8U/ T , <br /> cit /67d l r <br /> / �a3 G1/�-3/' � i72�a/ lr9r✓� Cit 1 loud t t / <br /> `rl iSS dl ITL llv /�J ���tSl�e�/f�/lni' <br /> City i t '?JJ r <br /> 1 &� ._ �TT�� /�9�✓� Cit <br /> Uc1 G X10 /S d /,f� � /�Lf1i�/�/1� L✓'j�t/ 7 Cit /t 57i` I i s l <br /> C g1 �/� �� ��� �5� � City <br /> Cit <br /> tilt <br /> cit / � 7 1 <br /> Cit // l ) c <l <br /> Cit I <br /> 02 n/ SX►0 ' o`Z 7 , l U i T � Cit <br /> cv/V L9 w /SU &;9S' M� G/qG- <br /> Page�_of <br /> EHD 42-04 <br /> 12/27/13 SEPTAGE CLEANERS REPORT <br />