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li <br /> RECEIVED <br /> San Joaautn Public Health S tikes J A A 04 2012 <br /> C1 lnvtronmenta( Health Servic sReportforthemonth <br /> of <br /> PO Box 2009(445 N.San Joaquin St.) ENVIRONMENTAL HEALTH <br /> Stockton,California,95209 sspo01 Submitted by:AM 5jZpjL0__ <br /> Fax:4540138 Cleaners Report <br /> Must be submitted by the 12th of each month Address: 0 $ rglYt)O �. 8'1 <br /> rn <br /> 0 <br /> co <br /> Date Name of Property Owner Address where work wasrformed <br /> Pe type waste gal,pumped disposal site <br /> • �, <br /> -Z it y ) tool il'. (.. t "•: <br /> taea 3 F� <br /> "Z n''ul LCtG''Z, Ii. �� ct 'y1 � � L�5'*.I?� I•i cc ;i y <br /> it it 2(}6 ttf <br /> Its ttLU <br /> LIS it IL U <br /> ccs �i cth , i a it <br /> 1.5 L 1t'fi 9f1 j �, er <br /> 0 <br /> 2' <br /> lafl ? ( 11 c Sd ; it r 't tt <br /> LUrx <br /> it <br /> rr <br /> The fouct a cerpt from the code of Federal Regulations.Section 403"Report must be signed by a corporate officer who can legally bind the <br /> pli It <br /> company" <br /> LPI certify under penalty of law that this document and all attachments were prepared under my direction or supervision. <br /> 17 <br /> 0 <br /> I <br />