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C <br /> RECEIVED <br /> APR 0 4 212 <br /> _ �ftn Joaquin Public Health Services <br /> a t ��l Z Environm ntal H alth � !.:5 ENVIRONMENTAL HEALI P"for the month of /Q'kZA r I <br /> PO Box 2009(44S N.San Joaquin St.) Septic Tank an(FRIMpppt ICES <br /> Stockton,California,95209 Submitted by: <br /> Ind, <br /> Fax:4640138 Cleaners Report <br /> 0 Must be submitted by the 12'h of each month Address:1Q$$�s �I tt t>flf� Wad/, ? 'Q <br /> Date Name of Property Owner Address where work was Performed type waste <br /> N �r �—� ��0 �1' _� - gal.pumped disposal site <br /> --'-f- z� <br /> �f?C_�t`52G>S It It 1000 a v <br /> 7 <br /> (A i16 <br /> .5 ILtaL 2l2 it t 16 DG k v <br /> � 35 S - 15 t.t r• <br /> lS u y <br /> 7 c�1LVi <br /> rlJ' -c �� ✓e$ ''LGJUCJ U y <br /> wC t r • - ci r< 1 wUl it 4 <br /> E F7Y <br /> 6ct r <br /> v <br /> lU]C�of7r . � �tb2e r stci9n L 0-0 } f. <br /> a 5 C. (- (_ (1-571) <br /> le� <br /> ��l% b r! <br /> The following est erpt from the code of Federal Regulations.Section 403"Report must be signed b a corporate ?D U � 4 <br /> a company g y porate officer who can legally bind the <br /> 0 <br /> I certify under penalty of law that this document and all attachmen were repared under my direction or supervision. <br /> 0 <br /> CDa — <br />