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RECOVED <br /> qq R SAN JOAQUIN COUNTY <br /> - f ijYS 1 t)-2415 E:NViRONMENTAL.HEALTH DEPARTMENT Return this form by:the <br /> 1868 East fiazelton Avenue, Stockton,CA 95205-6232 12th of each month <br /> o ENVIRONMENTAL HES`,' TOiephone:(20'31468-3420 Fax;(209}464-0138 Web:www. 12th <br /> LL eERM risER�nC�s SEPTAGE CLEANER'S REPORT <br /> Company Name: V f(� i ( � 3 • (( i { tIl- <br /> ? <br /> , <br /> 2^� f , `- Report for the Onth of: >l vKc I_ year< <br /> Company Address: a t 4e a� X17 "hymn <rx— ? „ F �. <br /> Signature: <br /> Atf information submitted must 4e com fete, accurate, and lelibfe - <br /> OATE ( NAME Of BUSINESS OR. ADDRESS'NHERE WORK WAS(SONE � GALLONS (Rl AESNA:Nnat. NAME OF TREATMENT <br /> PuMPrO ! PROPERTY OWNER PUMPED (G) RASE tAa.:. .FACILITY <br /> } ' V€EASE INC LV 6E STAFEY a ❑iA FC ilI)N, STREET uq(A AND .G l5Y C. GEASET <br /> [ FF <br /> sl <br /> PLL <br /> N <br /> 3 _R" <br /> i_`, _— � -- �tuft < 'i3V _�.-,... <br /> — <br /> o <br /> m ! 14 44 <br /> � �: -.. _(. ' ' ' _ 6c --. �''9,�' ..e'"Zi __ i YTS�,_��/,_, - a €��-t 4h✓j�`�t -,- <br /> 17� 44e <br /> tf <br /> WCk <br /> � <br /> - GFS€cv- <br /> 1 . <br /> s1 I lei Y h, &iewn_+ `t ztc �y{ {�% i —_ <br /> i -- <br /> { {� r <br /> d k C f - i ' t._ c tv L�t,`T°§T � E _� 1 Yt •j-� /'�_ m <br /> 17 o <br /> f@ v .dor <br /> IG <br /> J ,.. — .. ..._-. <br /> o fN'12 v . c Tyet <br /> SE-TAG CLEA,'If nif&-.FORT <br /> O <br /> F <br />