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c M ` <br /> C <br /> -60.' SAN JOAQUIN COUNTY <br /> W Y.„ ENVIRONMENTAL HEALTH,DEPARTMENT Return this form by the <br /> > ' ; tt <br /> i 1868 East HazeltonAvenue,Stockton; CA 95205.6 '1114e <br /> l� 12t" of each month <br /> ', relephone:(209).468-3420 Fax:(209)464-0138.Web.- <br /> se wvvw,sjgo ,org ehd <br /> SEPTAGE CLEANER'S REPORT iRaN�ENTAt <br /> J EWMITISE�VlC� <br /> Company game: ri.d Y1`l:l �, �; i Rep(?* or the month of: lun year <br /> Company r <br /> p y Address: <br /> ,n �� .'�4 - Signature: <br /> Street Address City zip:code <br /> All information submitted must be complete, accurate, and legible <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS (R) RESIDENTIAL NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER PUMPED IO) GREASE TRAP FACILITY <br /> PLEASE INCLUDE STREET 0, DIRECTION., STREET NAME AND CITY G CHEMICAL <br /> city <br /> l� T�.t,i'"�.� ���c� .1-i t Y,��Y�"l���fit•{.. �I �'�y'� Gf..,. � �'�'� �, r�/��.il't`�;�ar�„ 5���`"- <br /> � cit _ <br /> ry { ( 95775 PUPOS a v F 3 city ---baa 14�CT� <br /> Er A' _ <br /> 14 ftm-Fit6 Low p- , R10 <br /> Ne t mn : YG . lel j <br /> U 1 =/ 1� } ,�' t{ci.'7 {r£-iJ Git ~ ��'+. �_t3bb��.. 7-AA) <br /> cl -Frae� _ Tait. �rir' o <br /> 't t �f r_ t� �V t/(�t l� + �, • iy <br /> city <br /> _Tubeiid Ci <br /> FL <br /> 06,14 bik.ii CRY razl'A 111 <br /> t �11?�tG� tQ�.lAIstlLr> 1 r ' c <br /> ....... _ . .. <br /> :. <br /> ILl keedvkts L ? l !°�' iy� ! city <br /> I <br /> N a <br /> 0 � <br /> W _ <br /> lL <br /> EHD 42-C4 <br /> 1(]/4/07 SEPTAGE CLEANERS REPORT a <br /> o <br /> F <br />