Laserfiche WebLink
cRECD <br /> D <br /> MD�i;ry <br /> �JI��U SAN JOAQUIN COUNTY <br /> � �, ENVIRQNMENTAL HEALTH DEPARTMENT Return this form by the <br /> J F o ZJf4 186$East Hazelton Avenue,Stockton, CA 95205-6232 12th of each month <br /> E Telephone:(209)468-3420 Fax:(209 464-0138 Web:www.sjgay.o'rg/ehd <br /> N r ` ENVIRONMENTAL HEALTH SEPTAGE CLEANER'S REPORT <br /> PE PSER CES <br /> qy <br /> Company Name: ��G SLI Nall,� / Report for the month of: r"�'L �`� year 't <br /> Company Adciresst % % <`S �% ` �" 2. �jY�. ?�:'Vr' Signature: �ue <br /> ,r:tEFa. <br /> Street Address Clty Zip QDde: <br /> All Information submitted must be complete, accurate, and le Ible <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS (R1 RESIDENTIAL NAME OF TREATMENT <br /> PPUMPED (G) GREASE TRAP <br /> PUMPED PROPERTY OWNER PLEASE INCLUDE STREET N', D I R E Q TI.O.N, STREET NAME AND CITY C Ch1EMICAL FACILITY <br /> ` 0 1 Pu Pv-2' LaArbN-'.. ��t cit <br /> S16. (014 "s. <br /> Utz i l # <br /> city - r1-. CSL) '. ; =- <br /> c � T15 e r-�t P Ott Twpi N: <br /> O t 6tf'M ' a ' 15 !172 1 � } C�StLr� <br /> N <br /> N ' <br /> LiY1 i Ci �Y�C 1� JYs! 1 I rrt44 <br /> Ms`v " <br /> NI ! Traef. M u;n I-r- S-- j iia u- U City I en <br /> city <br /> AWIN r ,. kLc <br /> � C114 <br /> city W- <br /> isliq 7, <br /> exm' <br /> Clyj Tot <br /> Oar <br /> Citv <br /> )qz Will <br /> 5-7 '. `rIu�: i .�i <br /> ik (. pa Nei �t. >si.. c c�4 city Tyr <br /> l <br /> a <br /> (Cqhy _Qq D= ' Cit/co <br /> O <br /> N <br /> t71 a <br /> ti E.HD 42-04 SEPTAGE CLEANERS REPORT <br /> 10/4/07 111f� <br /> 0 <br />