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CEIVED SAN JOA1UlN COUNTY Return this form by the <br /> o ,>'- ENVIRONMENTAL HEALTH DEPARTMENT <br /> 6DD East Main Street, Stockton, CA 95202-3029 1Z`"of each month <br /> 10 0 1 2612 Tek orre:(209)4S&3420 Fax:(209)464-0138 Web:wwwAgOv.Orglehd <br /> 0-•' <br /> or" <br /> fa EPTAGE CLEANIER S REPORTENVIRONMENTAl I <br /> CompanV14i0116ERL-r Report for theSignatoCompany Address: ca r <br /> All information submitted most be com Iste, occurats and le tble (R} REsiodtwE NAME OF TREATMENT <br /> ADDRESS WHERE WORK WAS DONE GAL (G) rprE,�sE TRAP FACILITY <br /> DATE NAME OF BUSINESS OR PUMPED <br /> J PUMPED PROPERTY OWNER PLEASE INCLUDE STREET P. DIRE"tON, STREET NAME ANb CiTT C PIEMMJ1l <br /> Q <br /> W C' <br /> 2 <br /> J <br /> WC <br /> 0 <br /> O <br /> O' <br /> r <br /> W <br /> • <br /> C' <br /> OJ <br /> m <br /> m <br /> 0 <br /> v <br /> C)" <br /> m <br /> w <br /> m 011y <br /> r <br /> m <br /> m <br /> a <br /> CD <br /> CD <br /> IS) <br /> N SEPFAGE CLEANERS REdORT <br /> END 42-04 <br /> tomes <br />