Laserfiche WebLink
HEUENEI) <br /> v /� c, SAN JOAQUIN COUNTY ------- <br /> —s JAN 10 2014 <br /> D vt „ (� 'PMVT oNxrF.TIAL HEALTH DFPART°Nm—NT Return this form by <br /> A fP b c G�� IfL Street Stockton,CA 9520:5-21708 the 12`h of each month <br /> ENVIRONMENTAL HEALTH Telepl:one:(209)468--1420 Fav(209)464-0138 Web:www.sjgov.org/ehd <br /> PERMIT/SERVICES <br /> SEPTA-GE CLEANER'S REPORT <br /> LL Company Name: -,j Report for the ma Z�Z <br /> ; year_ � <br /> Company Address: J1&50 ti 1< rG� 7 t J - Signatures 2; <br /> Street Addr.ss Ciry Zip Coe. <br /> All information submitted must be complete, accurate, and IeLibie <br /> DATE `IAS QF BUSTi�TESS OR ADDRESS WHERE WORK WAS DONE GALLONS (R) RESmENTMjL NAME OF TREAT:ti1ENT <br /> PUMPED PROPERTY O INTER PUNIPED (G) CREASE TRAP FACILITY <br /> PLEASE INCLUDE STREET V. DIRECTION. STREET NAME AND CITY (C) CgEpIICAL <br /> �/ r �t _ � <br /> IZAL1I( fi9�r!�.d,fok�,4-- --' t � li�1}Tf' i�y!In .:✓ f G tJ�tl drlil ) r�l1.{ °t 4.tiL:1v <br /> Fnnn -i L\i}ld'.', 6o, 'I (u--p }�/ t-40 { <br /> `�;�7'�✓ r(iq� l"� Gty <br /> City <br /> N ' h 4!ANN, ci, <br /> �. I Y 1�liT ✓ I < <br /> o I(t I _ <br /> NU V5 <br /> 0 '�1� I"' , i• '/ J'� �)��r�^ fi:. L f %r <br /> ::�...i/� �..1,.r•- G �"�'�_F` � <br /> Pet�1�..✓T J .s�'?• �j,�' G{-�s!.�f"� "^ Cityw4;1-..-1` z <br /> 0\4 F- G ' l Li -T kat(' tv 4c,F <br /> ci / ±=f O✓• f "..'/.s� Tk�i6��"�-77x.1" .. c�-t <br /> J�y rt�rf 1vl.t: �Yil Jlic.ti ,(�'ir, r. -� II ;+;�i- Ti�'it 1 {i .Ti i} f3 rrl'( Fn M <br /> { 1 �►� htSr� .� itti3 ` <br /> city <br /> ciy <br /> city <br /> . T7�`f- y <br /> N t <br /> 'r <br /> - <br /> n <br /> a <br /> a a' <br /> d EUD 42-404 SeptidCesspoor Report <br /> 6 <br />