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. , RECEIVED <br /> p <br /> .qutN SAN JOAQUIN COUNTY JUL 18 2016 <br /> ' x ENVIRONMENTAL HEALTH DEPARTMENT F <br /> _WIROkfciVTgL N Return this form by the <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 pERI�TIS TALCE TH 12 of each month <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.org/e <br /> CLEANER'S REPORT <br /> Company Name: -2 P �' <br /> �' � � n'I �e1) Report fort m nth of: �/��� years <br /> Company Address:���� f(/��f%C2 ,�L> � Signature: <br /> Street Address Clty 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 C CHEMICAL <br /> !a0>fl r /��g/l1ZAf' c t % A410-00L�v� DD!!<lSS <br /> /D M/t>�(k0(I GVK/Gt �'� �' fL(�(/ Cit <br /> -4 <br /> Dlf(, /L rf <br /> -7 )v Dir 1922 /o ,4;4e City - <br /> a �itiC a S-S cG�l/ Cit <br /> cit <br /> / ' ci •L l-Q <br /> C <br /> lt <br /> cit <br /> �� c 3o Su X-1 Cit <br /> 6 Q �� �' /C�r� � city it r/ <br /> H Ri�9 Cys-alp �J3 s S@OC , Cit <br /> ✓� <br /> 26"33 Cit / d t / <br /> lei/l, �J-iJ, 4 t6 Cit I U i t l I <br /> city l Cl <br /> CityL! l l 1 <br /> Cit PCZ .7 rf / <br /> Cit <br /> Page of <br /> EHD 42-04 <br /> 12/27/13 SEPTAGE CLEANERS REPORT <br />