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C <br /> RECEIVED <br /> SAN JOAQUIN COUNTY <br /> zw,gst y " ENVIRGNSMFNTAI.,HFALTH DEPARTMEN-r <br /> s PR 1 $ 2019 Return this form by the <br /> F S 1868 Eas:Hazelton Avenue, Skockton CA 95205-6232 i2" Of each month <br /> E VIRONMENTAL HFAL i. Telephone: (209)468-;420 Fax:(249)464-Q 1,38 Wed:www.sjgov.org/ehd <br /> LL '' "'tg�. PERMIT/SERVEF�ES SEPTAGE CLEANER'S REPORT <br /> Company Name: rjit M, - ) ( � Report For the Ronthof. <br /> Company Address: ) t> G}L 6t Li <br /> Signature: 44 <br /> -— -- <br /> zipccuit a do <br /> Alt information Snbmitteo_must be complete, accurate, andt.e ible. <br /> OAY[ NAME OF BUSINESS OR y ADDRESS WHERE WORK WAS DONE GALLONS iRj Aesu�ENtu� ! NAME OF tREATMENT <br /> PUMPED PROPERTY OWNER- I PUMPED ! IGS CMVASE TRAP I 'OF YR A <br /> + PLEAS{: INC Wet" SIeEFT Y. tltRE:GiinN STREET NAME ANDCIFV G CNEbeCnt <br /> r 3 f {'�( P�/=?rv` i •.� Gi Pat k c. 01 <br /> Y <br /> n QA <br /> - , <br /> 4-1 <br /> ✓ / l Aid <#� `l its T A� t <br /> j7— <br /> cit, <br /> LJ <br /> o I -"t— <br /> � t--- <br /> CRY <br /> r {�1 <br /> Z <br /> f /}C{`y�¢ Y��'.}'\ . C� f 1.,.' a1•ts tL -u%.>r`x,- -t-(,� <br /> 1 Ll <br /> t%t4t.'i G <br /> _ t _ e�. P✓d _ ! r <br /> cft WTI.Ur <br /> s cq <br /> - <br /> _ I _ <br /> x <br /> .�� L��;��� utr��,�At== ,..�_ j �' 3u �-dr'�`t(t'� ���_ cm i ��f'n���? ��"ttF)^ ��.. �g1`��'� �f •� E <br /> 9aT CA; t " Y A,{rF� 1j`,� <br /> o <br /> as -- <br /> �' PHD A.Ct4 <br /> a t SEPTAGE CLEANERS REPOk-1 a+ <br /> O <br />