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Q San Jaaauin Public Health Services Report for the month of t ` ?1r <br /> Fnvir n gnt ealth SeryiCQS <br /> PO Box 2009 (445 N.San Joaquin 5t.) Septic Tank and Cesspool Submitted by: C In Cz <br /> CD <br /> C" <br /> Stockton,California,95209 Cleaners Report � � <br /> Fax:4640138 Address: b5g 1! d m <br /> I QI'1 'Y ,..• <br /> Must be submitted by the 12'b of each month = � i e <br /> c <br /> � c� <br /> coRate i` Name of Property Owner Address where work was performed type waste gal.pumped disposal site rmn �r <br /> Q 'r . •. 4 �'i ,f T <br /> 'y <br /> �J 7 "- s; <br /> r' <br /> i f s� r"�13;"2���',1�-{�1rTE�'?`� •;-. �' a• Vij l �� .� �� �-11 l l t i �'� l� y <br /> r'j� l: I`W F�1 t h <br /> c }cE I-0 <br /> Srx"Cf-;�'Z' 11 Il i4 f� <br /> . s; � �, t 7c i�" C .. �� <br /> ; - _ <br /> 'lei r=l,'�'' 'n"'11� f�{' --' �_. '.�f;,rF��? ` �� "''�, ''��������•1 ..�t't t�`?G�c� it <br /> ry y ,fir r T W <br /> r`� ! r`d!�'� ►` ',/{+°�1 S .T 7 -� 'IM}('f,l? ^f t��iJ C i� 3t <br /> ry r <br /> LLI <br /> r V <br />} .�1 j'�� 'V ��[,iU�{' 2L, iG3G <br /> i✓r �i'� Gi1 �' �7�i ` pec; `E N <br /> ;j�.�•��G'�'� iifiF�: <br /> x:11 '.{^,�^. ,1• _ ,{`l`) �"'� � ����; =4��I� �+ i I ��(� {L L( <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 /> N company" <br /> oI certify under penalty of law that this document and all attachments were prepared under my direction or supervision. <br /> O <br /> � + d <br /> �,� _ -� j •_C, f`, <br /> 0 <br /> z <br />