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IRECEIVED <br /> /o,t+q►ll��s SAN JOAQUtN COUNTY <br /> MAR 14 2014 ENVIRONMENTAL HEALTH DEPARTMENT Return this form by the <br /> m <br /> M. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 12"' of each month <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.ors/ehd <br /> SEPTAGE CLEANER'S REPORT r <br /> Company Name: t �Q 1 L �- Report for the month of:�(l l S-byyear �t`-f- <br /> Company Address: J® CICir y 5350 Signature: <br /> Streot Address city rip Coda <br /> All Information submitted must be complete, accurate and legible <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS RES""TIAL NAME OF TREATMENT <br /> PUMPED PROPERTYOWNER PUMPED GREASETRAP FACILITY <br /> PLEASE INCLUDE STREET N. DIRECTION, STREET NAME AND CITY C CHEMICAL <br /> cn <br /> city <br /> GA <br /> ViffCAtQ <br /> cfty <br /> cit <br /> city <br /> Cil <br /> d- <br /> city <br /> 0 <br /> City <br /> OD Q <br /> M city <br /> co <br /> CT) Cit o <br /> iD <br /> CD cilya <br /> N o <br /> Cit <br /> cit <br /> CSV CI <br /> CD <br /> CV <br /> city <br /> co <br /> m Eli❑42.04 SEPTAGE CLEANERS REPORT a <br /> m 10W07 <br /> r,- <br /> i i■%%i <br />