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.,, RECEIVED <br /> JAN 05 2of? C;Fosma <br /> San#oanuin—Public Health,Services ENVIRONMENTAL HEALTI{ Report for the month of { ,tr ALU <br /> CL Envirgrime la! Health_Services PERMITIsERVICEs <br /> PO Box 2009(445 N.San Joaquin St.) Septic Tank and Cesspool Submitted by: <br /> Stockton,California,95209 Gleaners Report <br /> Fax:4640138 -Address- 145 $ l� Q <br /> Must be submitted by the 12�of each month <br /> 0 <br /> Date Name of property Owner Address where work was performed !pewa,,e <br /> 00gal.pumped disposal osa!slte <br /> 0 c 512 1�vU � <br /> f v� Its, 1 's z14 x <br /> tb a E Ra►�rv � s ��240 �� (mac.)�Ph'[ ! l Lelr✓ 14aMAWrLin *10 s��s-uufir;�l int �t <br /> 3 Lf-Co <br /> 1 I l S S • <i7 u �+ <br /> 1� I - d.t <br /> C� re. td Lai oc « zt <br /> LIJ ?�. l 4U)0 Icy, <br /> tI <br /> o 12z-o cr <br /> Q l2�-�0 ., IG�Cir1 5U a �cA \ 5�tL q <br /> �-AJL <br /> lc� Z�S i ►1 c?U +`t 0 <br /> W <br /> 1 ���jf CIC i Iyi�Y��ii'' r 2LL�vl5c 5-f t- C)co <br /> L{ � <br /> Vl—lli 0 t t L tl r <br /> If u <br /> The following excerpt from the code of Federal Regulations.Section 403"Report must be signed by a corporate officer who can legally bind the <br /> company" <br /> I certify under penalty of law that this document and all attachments were prepared under my direction or supervision. <br /> r <br /> L4 i—1 <br /> r f <br /> n <br /> co <br />