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f � <br /> RECENED <br /> sanloaquin Public Health Services .OUT 1 2010 <br /> _—_ Report for the month of <br /> N nal l s ENVIRON MENI HEALTH -�� �Jl� <br /> ° PO Box 2009(445 N. San Joaquin St.) SeptR59MITA <br /> Stockton,California,95209 <br /> Fax:4640138 Submitted by: f <br /> Cleaners Report <br /> Must be submitted by the 12`h of each month Address; D5$ r-* <br /> . rn <br /> Date Name of Property Owner Address where work was performed <br /> �, Z �� �. type waste gal.pumped disposal site <br /> °o <br /> � . r <br /> 09Z5 7 <br /> Z <br /> Ealiz <br /> Lk E( <br /> LU <br /> O <br /> O <br /> a <br /> Q <br /> LU <br /> C0 <br /> The following excerpt from the code of Federal Regulations,g ns.Section 403"Report must be signed by a corporate officer who can legally And the <br /> com{aany <br /> CL i certify under penalty of law that this document and all attachments were prepared under my direction or supervision. <br /> 0 - <br /> co <br /> 0 <br /> 0 <br />