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m SAN JOAQUIN COUNTY <br /> EWIROUMENTAL HEALTH DEPARTMENT Return th=1orrm"by6DD East Main Street, StOcicon, CA 95202-30291 T1hof ea <br /> L Telepffone:(209)466-3420 Fax:(209)464-0136 Web:www.sjgov.Drglehd <br /> a " <br /> _ SEPTAGE CLEANER'S REPORT n , <br /> Company Name: <br /> EZ-1 4 C�L Report for the month of: year �J— <br /> f <br /> 3 V X11 Signature: <br /> Company Address: <br /> steel A:d6w.f{ <br /> All inform tion stlemitted must be Complete. "Cursts and 10 11-1 (R) REsloml t NAME OF TREATgENT <br /> ADDRESS WHERE WOR WAS DONE GALLONS (G} GREASE Tags FActLt y <br /> DATE NAME OF BUSINESS OR *UNPED <br /> PUNPEO PROPERTY OWNER RIEA{{ INCLtl tl! ST0.E E7 I, OIRCCllO N, {TRlET YAME ANO CITY CIWW <br /> J <br /> c' I <br /> J <br /> H <br /> W <br /> z <br /> Z <br /> O <br /> d' <br /> } <br /> W <br /> 40 <br /> �. <br /> cft <br /> � C <br /> c 9 <br /> m <br /> M <br /> � LL <br /> UD C <br /> � I <br /> N ME N I AL HEALTH <br /> c <br /> PEI Mff <br /> m <br /> cer <br /> m <br /> m <br /> N <br /> m <br /> � sEPfAGE CLEANERS REPORT <br /> EHD exp <br /> lom07 <br />