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o .r` SAN JOAQU(lJ COUNTY <br /> ENVIRO`JAAENTAL fIEALTH DEPARTMENT Return this form by the <br /> R ' <br /> 12 <br /> 600 East Main Street, Stockton, CA 95202-3029 of each month <br /> `h <br /> < Telephone:(209) 468-342D Fax:(209)464-0138 Web:www_sjgov.orgfetd <br /> i 77:-,` <br /> SEPTAGE CLEANER'S REPORT i <br /> Company Name: 1 V� 1! —kJ �`�'� G-` r V , Report for the onth of— � � year �l <br /> (, <br /> Company Address_ i Signature. <br /> S,ree.Adams COY �ooae <br /> I � <br /> All information submitted most be coal late, accurate arid le Ible <br /> = DATE NAME OF&MINM OR ADDRESS WHERE WORK WAS DONE L043 (R) NAME OF TREATMENT <br /> J PUWEO PROPERTY OWNER PUMPED (G) GREASETRAs FACILrTY <br /> Q PLEASE INCLUDE STREET t:, DIRECTION, STREET 14AIRE AMD CITY C Cf1ELi <br /> Y4CJ�L <br /> alp L ct 250CIVAw <br /> H <br /> 7 <br /> 7 <br /> W t <br /> 1 <br /> City <br /> i <br /> { cRoom <br /> I <br /> IU1 <br /> 5 <br /> C4 L <br /> 'ZIVVIRP9 n ON E_TM <br /> DERVICES <br /> T <br /> c' <br /> D <br /> N <br /> city <br /> -i <br /> -1 <br /> 9city <br /> V <br /> r I <br /> J <br /> ti <br /> Eta 0Z-0L <br /> SFPTAGt CLEANERS REPORT <br /> ?Otalp7 <br />