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'in Joaquin Public Health Services Reportfor the month of <br /> N ` <br /> d lenvironmental Health c <br /> PD Box 2009 (445 N.San Joaquin St.) Septic Tank and cesspool Submitted by:AM-5 <br /> Stockton,California, 95209 Cleaners Report <br /> Fax <br /> Mustbesu 8 Address: (05x33 S.,gt►�Ot'f / �q <br /> Must be submitted by the 12u'of each month <br /> rn <br /> 0 <br /> Date Name of Property Owner Address where work was performed type waste gal.pumped disposal site <br /> l Z v1S IleSv ii (t52Cxo <br /> 60 k1l" <br /> Lot <br /> k <br /> I ( =IL It y t� q <br /> ICUS u it <br /> MC <br /> V' S U a <br /> 5-t1L 952 l t` U., cc <br /> -71 U LiU ti G <br /> li - z « t k <br /> w V? SMo v- 5tk- qsZt , <br /> o c fc� 722 N uw 4� u eS' hal oUc� `� w <br /> C, rl, ct t <br /> Z - Io s <br /> Ofollowing <br /> 1 Luu t u <br /> a ( K <br /> � <br /> Asi <br /> S'1zt I� 12 0 �t <br /> � ti r Uderal 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 /> 0 <br /> 0 <br /> 0 <br /> CD <br /> N <br /> ti <br /> 0 <br />