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RECEIVED <br /> �}U909 2012 (D <br /> San Joaquin Public Heal Ser ices // <br /> Environmental He^ h S s ENVIRONMENTAL HEALTH Report for the month of /� I Z o <br /> PO Box 2009 (445 N.San Joaquin St.) PERMIT'SERVICES <br /> n Stockton, California, 95209 Septic Tank and Cesspool Submitted by:AM ,jpf}{yC <br /> Cleaners Report <br /> Fax:4640138 -- <br /> Must be submitted by the 12th of each month Address: <br /> m <br /> ti m <br /> pate Name of Property Owner Address where work was performed <br /> ti C-)—Z (� type waste gal,pumped disposal site z <br /> 2 <br /> ti �i C l o <br /> w <br /> fi 0 <br /> —2 S t t, 0 ,, [/ <br /> S p , <br /> S1 w ii I Q tt it <br /> l v <br /> 11 4 Z(76 <br /> it v' <br /> est ^ r " G7eivtCee � loo �� �� <br /> l S Cl �1 t/ 5 sl •t f <br /> tv . I1 eV lac 5>7c 5 <br /> 60 „ u <br /> icy �n a! N <br /> r ' (, aS215 n u II `7 <br /> It a o <br /> Zo Z i o <br /> �U Z- 2P I bOO <br /> The following excerpt from the code of Federal Regulations,Section 403 "Re ort must be signed b f a corporate li I I <br /> company' P g y porate 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 />