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6i=6EP 1, 0 2010 <br /> EN!lIRUNPa,L_fV_II_ HEALTH <br /> Environmental HCjIth Services <br /> San Joaquin Publit_Healt_h_Services PERMIT/SERVICES Report for the month of� <br /> 4 <br /> PO Box 2009 (445 N.San Joaquin St.) Septic Tank and Cesspool Submitted by <br /> Stockton,California,95209 Gleaners Report <br /> Fax:4646138 th -Address: t�5`$ rf- I <br /> Must be submitted by the 12 of each month <br /> 0 <br /> 0 <br /> MDate !Name of Property Owner Address where work was performed type waste gal,pumped disposal site <br /> 51 k <br /> ti K <br /> ad. wol�eo 2-74L5 41 <br /> a a � <br /> - aS V `( 4�_ Gi <br /> �. <br /> _ est-G�se. at � <br /> Rubins G u LA u a <br /> deb-n 4A CL LL 3 © ct r, <br /> 1Y, �t C 1�u � z l <br /> L 1 ZCX3 u <br /> - . �A(f0? )a 2D t <br /> w 2:Rb <br /> z <br /> U <br /> u1 <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 /> CV <br /> r <br /> d <br /> Q . <br /> c <br />