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C <br /> N <br /> ro �'I r ; <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Return this form by the <br /> 1868 East Hazelton Avenue,Stockton, CA.95205-6232 <br /> 12t"of each month <br /> o Telephone:(209)468-3420 Fax.(209)464-0138 Web:www.sjgov.org/ehd <br /> } SEPTAGE CLEANER'S REPORT' <br /> Company Name: U) l'L�t r 1� !� .� r' �(� Report for the month of: year <br /> Company Address: � i <. �fitI �f- 1 01-1 - ` <br /> Street Address ! City Zip Code ,. {g <br /> All information submitted must be complete, accurate, and le ible <br /> i <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS (R) riesioENnAL NAME OF TREATMENT <br /> PUMPED PROPERTY OWNERPUNIFED (G) GREASETRAP FACILITY <br /> PLEASE INCLUDE S i REET N, DIRECTION, STREET NAME AND CITY I C CNEdtICAL <br /> r <br /> chL. "Fres i 1 ivf Yet t { <br /> �Citr <br /> i Cit l"aher 1- ame,w 3 ; <br /> tt <br /> l <br /> 05f22111 q, I Mt Yl'tilil r L 'Iwlavr <br /> ice' yy'}}�V , � <br /> t t City _ tit �a <br /> �� <br /> N .� t La1L�4 G fyd/i tit SSC t11 f�l �G toTrEcity <br /> c, r/' '7 7 � r. ms's ail, Y _ ;t -`�` ?C-6 <br /> r <br /> jpq i`Lft11 ; 1 S . h-c r7-vd Cv t' 3tno - W41 V )`1 \ CA <br /> , <br /> k.l. <br /> citvo <br /> z <br /> city �I <br /> d <br /> Ci Cr <br /> cityo <br /> Cit I <br /> cri <br /> Cit <br /> - <br /> city <br /> Ci <br /> p city o <br /> co <br /> N <br /> d 10//07-O4 SEPTAGE CLEANERS REPORT <br /> n- <br /> o <br /> f- <br /> { <br />