Laserfiche WebLink
Qr,4KIfY c <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Return this form by the <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> fl Telephone:�'f Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd 12tn of each month <br /> 1 - SE//P�T,,AGE CLEANER'S REPORT <br /> Company Name: � C �/' N ��^ C.�J ./� � 60 Report forth nth of: �/✓G years/ <br /> Company Address:���� j rC ��• , <br /> Street Address Signature: J (� <br /> city Code <br /> All information submitted must be com tete accurate, and legible <br /> DATE NAME BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS <br /> PUMPED PROPERTY OWNER (R) REBID- TIAL NAME OF TREATMENT <br /> PLEASE INCLUDE STREET # DIRECTION STREET NAME AND CITY PUMPED GREASET FACILITY <br /> 4 !— CHEMICAL <br /> cityG, , J U,� <br /> N ,Vi02 Cit 7 /i <br /> city. y�l <br /> .�C ti/r%'�/ l <br /> City <br /> cit <br /> Cit <br /> cit <br /> city <br /> Ci <br /> ci <br /> c. <br /> cit <br /> cl <br /> Cit <br /> Cit <br /> Cit <br /> Clt <br /> Page of, <br /> EHD 42-04 <br /> 12/27/13 <br /> SEPTAGE CLEANERS REPORT <br />