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San Joaau_in Public Health Services Report for the month of t <br /> a n Heal P 6 � <br /> PO Box 2049(445 N.San Joaquin St.) Septic Tank and Cesspool Submitted by: C —� <br /> Stockton,California,95209 Cleaners Report ' <br /> Fax:4640138 Address:_165-93 Q <br /> Must be submitted by the 12t"of each month <br /> rn <br /> 0 <br /> M Date Name of Property Owner Address where work was performed type twaste <br /> 0 '� r )��5 ,J_: iz'r i ` #���. �" ,�> ``, gal,pumped dl;posalsite <br /> IL <br /> LZI104-PlIr 4.1 -Y <br /> r <br /> w <br /> I-- <br /> O <br /> O <br /> Z <br /> Q, <br /> U <br /> n <br /> a <br /> LU <br /> CO <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 /> 1 certify under penalty of law that this document and all attachments were prepared under my direction or supervision. <br /> 0 - -10 <br /> o . . <br /> 7 <br /> O <br /> Z <br />