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RECEIVED <br /> SanJoaguln Public Health services SEP 1 2012 I <br /> o Environmental yg��+h c" — Report for the month of U4W, 2JrZ <br /> rvices ENVIRONMENTAL HEALTH <br /> PO Box 2009 (445 N. San Joaquin St.) Septic Tank and Cess §WITISERVI y,W S„r.h� �nC <br /> Stockton, California,95209 emitted b : `#-�L <br /> Cleaners Report <br /> Fax:464013E <br /> Must be submitted by the 12th of each month Address:1OS',93 <br /> m <br /> 0 <br /> Date Name of Property Owner Address where work was performed <br /> type waste gal. pumped disposal site <br /> w ? r <br /> o a� 20 G j y1 <br /> .YA 5 52 a c. <br /> E. tlL it II p C) LL n <br /> e, < CN' c t� tI C tL 61 <br /> C D 4 t <br /> v q5 LI <br /> Ul-i2d Mon- V4.0 ' I D - 1 Y OC `(1v SZ IL L( Lt <br /> 5C J Pt !r o <br /> D 2Cl <br /> k <br /> Y � � 2 � I <br /> C <br /> u <br /> The following excerpt fir on the code of federal Regulations.Section 403 "Report must be signed by a'corporate officer who can legally hind the E <br /> company <br /> z _ <br /> 9, I certify under penalty of law that this document and all attachments were prepared under my direction or supervision. ~ <br /> 5 <br />