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RECEIVE® <br /> FE H 14 )'j? <br /> San Joaquin Public Health Services__ ENVIRONMENTAL HEALTH Report for the month o J(�t jJ A( y 7i <br /> n Cnvironmental Health Seroi PERMIT/SERVICES <br /> PO Box 2009 (445 N.San Joaquin St.) Septic Tank and Cesspool Submitted by:AA] Swlic, <br /> Stockton,California,95209 Cleaners Report <br /> Fax:4640138 Address: 16S'$3 9.AfrOD► <br /> Must be submitted by the 12th of each month <br /> 0 <br /> 0 <br /> Date Name of Property Owner Address where work was performed type waste gal.pumped disposal site <br /> I 'S 21 - MS lG 6 L21J llC�C'. <br /> N e-41 VOL i <br /> 1-1 L4e <br /> r c — ir q y <br /> 23 Z3 CSG CCWI q5 rl. l� 3 �0� w <br /> L l 1 C k 4 <br /> I 3-73 tc it <br /> Vic � C I z o oa <br /> 30 '�'U Alnu place- 7 u cc i <br /> w <br /> 2��D ,�o _ tab <br /> -21 YL o i1 t t v". ( 1 L c l q <br /> Y . " `ZtU t K 2GjU 4 v <br /> a <br /> COUG ti u <br /> w <br /> The following excerpt from th <br /> company" e code of Federal Regulations. Section 403"Report must be signed by a corporate officer who can legally bind the <br /> I certify under penalty of law that this document and all attachments were prepared under my direction or supervision. <br /> 0 <br /> v <br /> 0 <br /> N <br /> 0 <br />