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i <br /> RECENED <br /> Sap-Joaquin public Health Services AUG o RI 'O'r <br /> nvironmental Health Services porta <br /> or the month of <br /> qwuNMENT HEAL` HPO Box 2009(445 N.San Joaquin St.) Septic Tank and CesspERM1TORNEGby. C <br /> Stockton, California, 95209 Cleaners Report <br /> Fax:46407.38 Address:_O 93 S A � Ulf i, �►'j�C� <br /> Must be submitted by the 7.2`x'of each month -0) <br /> CD <br /> 0 <br /> CD LO <br /> Date Name of Property Owner Address where work was performed type waste gal.pumped disposal site <br /> CO l <br /> Ll tj <br /> o r '# <br /> aton <br /> I CL" <br /> tnik-EcA. 2L952-17 <br /> 3o w <br /> 1 Ifo. ' �,t. R5Z3 b '� u �C C) u <br /> �P v a `2 Cl <br /> !MSS ST"A,9S`w} �� Lt r�► u <br /> RA Fr-':'52-31 9 H L O � y <br /> 7-11HOL2 i U <br /> W , f u <br /> ° G41!S 5 A (4 SZ� vL Lf <br /> U <br /> 33 6 Cay 3 <br /> CL <br /> LU <br /> U) <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 /> NI certify under penalty of law that this document and all attachments were prepared under my direction or supervision. <br /> 0 <br /> o f <br /> a <br /> Q <br /> U) <br />