Laserfiche WebLink
aS,4Rtl'1,� <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Return this form by the <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 12t1' 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: 1 (Jl 4 S& tm ,�/�' Report for the nth of: d t l ei/c year <br /> Company Address: �3 '' — -) gT <br /> Street Address Signature: <br /> City Zip Code <br /> All information submitted must be com tete, accurate, and legible <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS (R) RESIDENTIAL <br /> PUMPED PROPERTY OWNER ) GREASE TRAP NAME OF TREATMENT <br /> PLEASE INCLUDE STREET #, DIRECTION, STREET NAME AND CITY PUMPED C CHEMICAL FACILITY <br /> � s �ya3/V 71t , Cit <br /> 6-i k4 City. 1( / <br /> p� IiIr7/7� �Vao N. / Oal� Cit /�LUt <br /> Cit <br /> 177 1-3zqA 1)�wx&AIJ77 city <br /> cit ( �✓(/(/ C, <br /> `S �© A Cit <br /> OA <br /> Cit <br /> ^L Olio C466 /06-4` / /i77 0' /,t/ cit ! �( <br /> C&;rk P-.SIDE a� <br /> / l loo%/ lam/CS Ui7/Cil/l¢G cit <br /> city <br /> 7Y� rL GfJf�l% �vU ��JC/L��/tF.i`l ftJ Cit f 11(/U <br /> s <br /> i�do/G City <br /> Cit <br /> cit l I /SUv I <br /> Page 3' of <br /> EHD 42-04 <br /> 12/27/13 SEPTAGE CLEANERS REPORT <br />