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RECEIVE® <br /> AUG X18. 1 <br /> ENVIRONMENTAL HEALTH <br /> _ San Joa uirz Public Health S rvicesdSERMES <br /> Report for the month of � _ <br /> Q viron ntal a It Sery <br /> PO Box 2009(445 N.San Joaquin St.) Septic Tank and Cesspool Submitter! by: C, <br /> Stockton, California,California,95203 Cleaners Report <br /> Fax:4640138 Address: DS$ M/a <br /> Must be submitted by the 12u'of each month <br /> o <br /> Date Name of Property Owner Address where work was performed type waste gal.pumped disposal site <br /> � -! rr � ` <br /> CD <br /> AL $ L1 t! 2fa0 <br /> " SCt vi u 14In In r- <br /> k <br /> 4 2-U <br /> C •- <br /> ---� 1 <br /> E I . <br /> n 0, s <br /> ' El = �L !i GC <br /> H <br /> W fJ <br /> o Z�U t t c+ <br /> Q a! rt <br /> G[ <br /> ' <br /> a ol , . 3 It �t <br /> �c u <br /> r' <br /> q . cep. ,U ct t1 <br /> The following excerpt from <br /> company" the code of Federal Regulations,Section 403"Report must be signed by a corporate officer who can legally bind the <br /> � <br /> 1 certify under penalty of law that this document and all attachments were prepared under my direction or supervision. <br /> co <br /> 0 <br /> NJ- <br /> CD ✓3� <br /> U <br /> 0 <br />