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ENVIAaNMII.TTAL HEALTH DEPARTM NIIT Return this term by <br /> N 600 East Male Street,Stockton,CA 95202-2708 the Wh of each month <br /> m <br /> N TeFeplforte. (209)468-3420 Pme:(209)464-0138 Web:www'sjgovotg/ettd <br /> SEPTAGE CLEA M'S REPORT f <br /> IL C �C - Report for the moa&,& Y�r�U�' <br /> CompaDy Nante: —7 <br /> CompaDyAddnes f Sign"AW e- <br /> SamAddren ,. <br /> All informalioD sD6mitt<d most 6e com iete, acearste. and legible <br /> GALL.O'.S wslD�rTuc NOEOR2RE.ATMOa <br /> DATE NAMLI `FS <br /> Orl"ISH SOR ADDRESS%,,UWE"RK WAS DONE P11N�SD (G) GREAS£'OL1P FACILITY <br /> TUNIFED L'WFERTXOWN'ER PLEASE IKCLD DL ST0.CYT N, IIf0.IC7i0 N. STREET FAME AND CITY CBYM1SICAL <br /> F � <br /> J <br /> O <br /> O <br /> H <br /> C, <br /> Cav <br /> Q <br /> W <br /> Ih <br /> H <br /> @ <br /> Q <br /> IL <br /> Q <br /> Q1 <br /> CY <br /> Vf <br /> ll] ti <br /> �C> <br /> a! <br /> rl <br /> CLI <br /> f-I <br /> m <br /> N <br /> N <br /> N <br /> r <br /> SqdrKctpW1 ItspaR <br /> EIM 4,dt <br />