Laserfiche WebLink
REcE-IVED. <br /> 9" <br /> ull§ <br /> SAN JOAQUIN COUNTY 2016 <br /> ENVIRONMENTAL HEALTH DEPARTMENT EW/RQ1868 East I-lazelton Avenue Stockton CA 95205-6232 pE �,"gE'yTALHEAL Return this form by the <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd M,7,f,FHVICES 12th of each month <br /> SEPTAGE CLEANER'S REPORT <br /> Company Name: <br /> Company AdReport for th nth of: JC.9� year <br /> Address://9-50 �j`/_=f%G,/� ,��.� � � � � 3 <br /> Street Address city Signature: <br /> Zip Code <br /> All information submitted must be complete, accurate, and legible <br /> DATE NAME OF BUSINESS OR <br /> PUMPED PROPERTY OWNER ADDRESS WHERE WORK WAS DONE GALLONS (R) RESIDENTIAL NAME OF TREATMENT <br /> PLEASE IN STREET # DIRECTION STREET NAME qND CITY PUMPED GREASET FACILITY <br /> L � � �/ / CHEMICAL <br /> rLrL /(I UU( J ci �sCll/ / v <br /> srr <br /> Aeolco <br /> o"(l i✓✓U-�JrtTr3u� /D ---------------------------- <br /> cityyS�Ii� , I <br /> Cit <br /> cit r I /Svc <br /> %Gta J /0'1 AlIM7 H s,77 c; C� l o?�^ i , , <br /> /J. cih, , I 600 <br /> cit > I as <br /> C's� C d�t/E t <br /> Cit I I OldCity <br /> Z <br /> A/-Pd pit <br /> cit <br /> D W AKZ-& " Z411-ve cit 1 <br /> _ L city 11570IfL E, , <br /> cit <br /> a w. h7 Cit <br /> EHE 42-04 Page of S-- <br /> 12/27/13 <br /> '12/27/13 <br /> SEPTAGE CLEANERS REPORT <br />