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RECERED <br /> QCT 1� 1 2090a�- <br /> San Joaciuin Pu 'c Healt Se ices <br /> E r n f Balt ervE a ENVIRONMEN] HEALTH Report or the month of C 01 <br /> a PO Box 2009(445 N.San Joaquin St.) SAP#TT�at�V1Gl_S <br /> Stockton, California,95209 nk.an esspool Submitted by: �� � <br /> Cleaners Report <br /> Fax:4640I38 <br /> Must be submitted by the 12�h of each month Address: DS$ rf <br /> O Date Name of Property Owner ,Address where work was performed e <br /> typ waste gal. pumped disposal site <br /> VIl <br /> R- kd <br /> 5 �s <br /> e — C' 6e4,-,��a <br /> � <br /> pm4 <br /> it <br /> ? terlz r' JC�DI u yi <br /> ZI ! <br /> R21 MM t quti► �, <br /> �� " 1 DDU �c W <br /> is v Sac � it <br /> 000 <br /> C'.r <br /> S rCZj), cc [r <br /> e Y •21) <br /> .V17&t; Palm <br /> ODO <br /> C !{ <br /> _ _ <br /> Varl1I n <br /> ~� koz <br /> rJ LIrG�GA <br /> 1530 UII - <br /> The following&cerpt from the code of f=ederal Regulations.Section 403 "Report must be signed !� <br /> company" g by a corporate officer who can legally hind the <br /> CL I certify under penalty of law that this document and all attachments were prepared under my direction or supervision. <br /> r? - <br /> ti <br /> o —•• <br /> 0 <br />