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a►41K1!t, a <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Return this form by the <br /> "'';;��sr� `�• Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd 12th of each month <br /> SEPTAGE CLEANER'S REPORT <br /> Company Name: 7�:�J Ri'i/ /l <br /> Company Address: /�,3�") - Report for thegnth of: earoZU/ <br /> Street Address Ciry Signature: l�2'�Zr`i✓ <br /> Zip Code <br /> All information submitted must be com tete accurate, and le ible <br /> DATE NAME OF BUSINESS OR <br /> PUMPED PROPERTY OWNER ADDRESS WHERE WORK WAS DONE GALLONS (R) RESIDENTIAL <br /> PLEASE INCLUDE STREET #, DIRECTION, STREET NAME AND CITY PUMPED U GREASETRAP NAME OF TREATMENT <br /> C CHEMICAL FACILITY <br /> D <br /> Cit <br /> ` 020 Lt/. 8�> . �ui iE at <br /> /�/ �'• i!�C'/ .�90v" cit // <br /> v <br /> Cit J� <br /> cit <br /> 5(23 <br /> h?r O Ld Or✓ S( ci / i 0?s— <br /> r� 9 v s <br /> T�n�T city <br /> / I S RIV C° <br /> L U/ % /i'C/t 4,1 Cit I I .� !1 t / <br /> J�� J <br /> ✓ � L Gtf � � :f � �,/ cit � � I � 1 1 <br /> Cit <br /> city <br /> h c ,✓ ros- <br /> i � <br /> t i <br /> )9i�IrlC�11�1/Crt <br /> cit J/ 44-e li /i I <br /> Cit <br /> Gti? Z dYG /�! i5��/�•9atC`/ cit /✓SOU iii r l <br /> EHD 42-04 Page . Of 5 <br /> 12/27/13 <br /> SEPTAGE CLEANERS REPORT <br />