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RECEIVED <br /> FEB 11 2016 <br /> SAN JOAQUIN COUNTY <br /> "`. ENVIRONMENTAL HEALTH DEPARTMENT ENVIRONMENTAL H <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 PERMIT/SER"C S Return this form by the <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd 12 of each month <br /> SEPTAGE CLEANER'S REPORT <br /> Company Name: Z�' rb <br /> Company Address: 9 Report for the nth of:�Tj- <br /> p y //3��Ci��i�- ,t3�ulGyear <br /> � �� �y�( <br /> Street Address ,3 Signature: , <br /> City Zip Code A—/ <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 (R) RESIDENTIAL <br /> GALLONS NAME OF TREATMENT <br /> j PLEASE INCLUDE STREET #, DIRECTION, STREET NAME AND CITY PUMPED GREASETRAP, <br /> CHEMICAL FACILITY <br /> ZAK e, city <br /> City <br /> City <br /> D v j <br /> �� /tG t fC• � /Sas- A <br /> Dt `JAG I c I I <br /> Cit <br /> Cit <br /> Aa GI/ I <br /> oZ 6 L /�d ���Z,.)& Cit 3 1)4) !I <br /> Gv� TlIE Cit <br /> u hilvt R3 6 /i/, <br /> Cit <br /> Cit <br /> JLC�� lLd�i ee li¢i✓C city <br /> Cit -------------- <br /> cit <br /> Page / of <br /> EHD 42-04 <br /> 12/27/13 <br /> SEPTAGE CLEANERS REPORT <br />