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r SAN JOAQUt COUNTY <br /> Re'Wrn this form by the <br /> EWIRONNEMYAL HEALTH DEPARTMENT <br /> . 4. 600 East Main Street, Stockton, CA 95202-3029 12t° of each month <br /> Tefephorre:(209) 46&3420 Fax: (209)464-0136 Web:www.sjgov.orgfehai <br /> S�E-P.(TAAGE CLEANER'S REPORT <br /> Company Name: I V V �/6 r� f�c/ I v� �f '� I GV 1� —� ReAo+t far!fis onth of: year <br /> P Y <br /> Company Address: ISS 1.3 IN Signature <br /> Swat Aaapbsc cit Lv kmoc <br /> All information submitted must be coal late, ao6urata and legible � <br /> = DATE NAME OF EM)SI>'M OR ADDRESS WHERE WORK WAS DOBE GALLOWS (R) NAME OF TREATMENT <br /> PUWED PROPERTY OWNER � �. FACILITY <br /> J FLEASE INCLUDE STREET f, OIRECTLON, STREET NAME AND CITY PISMPED (;. CMEhb'L, <br /> 1. P Iy <br /> 7 <br /> 71 <br /> T <br /> 2: city 67 <br /> ALE ftrt. <br /> 01 - rt ( U.fb <br /> > <br /> T 1.. <br /> W <br /> ctf <br /> cw <br /> D C <br /> CollH <br /> Ow <br /> Sl <br /> v <br /> D i <br /> v <br /> T. <br /> GAYD <br /> V <br /> city <br /> r <br /> -r Cir <br /> D <br /> tiCkv <br /> D <br /> V <br /> s <br /> T <br /> ~ Ero 42-0 - SEPTAGE CLEJ NE RS REPORT <br /> 10""7 JAN 0 7 2019 . <br /> ENVRONMENTAL HEALTH <br /> PERMIT/SERVICES <br />