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RECEIVED 61 <br /> San Joaquin Public Health Services A(Yo s 2012 Report for the month of GfJ Z <br /> a <br /> Environmental Health Services ENVIRONMENTAL HEALTH <br /> PO Box 2009 445 N.San Joaquin St. "°""TrSERVICES <br /> 1 Septic Tank and Cesspool Submitted by:444 ip ffInd_ <br /> Stockton, California,95209 Cleaners Report <br /> Fax <br /> Mustbe sub Address:1O5g3 � �lr►-tx�or--F Way, A�(� <br /> Must be submitted by the 12�h of each month <br /> m <br /> 0 <br /> Date Name of Property Owner Address where work was performed type waste gal. pumped disposal site <br /> o - 2- <br /> �I Q <SpVt �' ZO :'>rP� I L©0 t v <br /> '( s 7o II I Q q it <br /> G it ri O Li 0 <br /> a5212 I� iI 10d <br /> —I eS1" r Cheiv(L2e c,,� Si p rr r _ <br /> l 5 ev VIC07Stuq S ; I Z h i, o <br /> L � 2 <br /> LIDl i u <br /> r d0 524 D �i r p ; n <br /> Q t 'ICJ ( X15215 it n 12fj if a . <br /> ,ZUZ <br />.0 J I i^ 52U it 107hn Iit ti ` <br /> The following cerpt from the code of Federal Regulations,Section 403 "Report must be signed by a corporate officer who can legally bind the <br /> company, <br /> CL E <br /> I certify under penalty of law that this document and all attachments were prepared under my direction or supervision. ~ <br /> V <br /> d^ <br /> Q <br /> ■titi* <br />