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SAN JOAQUIN COUNTY <br /> ENviRomAE-NiAF.HEALm DEPAR1Yl5GwT Return this form by <br /> AML <br /> ' 304 Emf Weber Avenue,T'Flom,Stockton,CA 95202.2708 the 12"of each month m <br /> ToMpheae(209)468-3420 Fax:(2119)464-0138 Webr www.sjgovorgland ° <br /> m <br /> J SEP CLEANER'S REPORT <br /> aCompany Name: C 1\ ,1IG 1�l'c }� X Report for the month of: year LCI Z <br /> Company Address22�6 IVAJJ� i>rJ KLL- �S��i Signature: <br /> arra Ad{rzla On 7'y CoAr. <br /> All luformitieD submitted must be com Itte Atturalt, Sad It imilt <br /> IR) WSIDENRII. <br /> DATE NAME OF BUS[KP.SS OR AIYDRESS II'IDCAB WORK ItlAS GONE GAI,LON6 (0) GRERSETxAv NAME OF MATUMT <br /> PUMD FROVERn OWNER ?LEASE INCLUDE STREET N. UTAECTIOR, STREET NAIEC AHO Cirl' P1Rtl?CD Cy/plW,pty- PACD'QY <br /> L t t�• Ely U L t'_"` <br /> ABY <br /> tQ MY <br /> W MY m <br /> H M <br /> O <br /> O City O <br /> a <br /> cky <br /> ai N <br /> Qn' <br /> Cig m <br /> 0 <br /> coy <br /> 0 <br /> z <br /> QL <br /> b :5i <br /> D oyQ <br /> ID <br /> p <br /> Cllr <br /> Dc <br /> 9 V Wit, r <br /> N o <br /> OlY M <br /> H N Lr <br /> D O MY o <br /> N D O <br /> 9 Cin <br /> O <br /> N U 04 O a <br /> N E <br /> 9 N Ln <br /> V ' v <br /> D <br /> fl i EMD 42-04 x <br /> ° 8/90/04 ' <br />