Laserfiche WebLink
-4 CEIVED <br /> SAN JOAQUIN COUNTY <br /> 2017 ENVIRONMENTAL HEALTH DEPARTMENT Return this for <br /> 1868 East Hazelton Avenue, Stockton, CA 95206-6232 m by the <br /> .`�� .ONMEN TAL HEALTH Telephone:(209) 468-3420 Fax: (209)464-0138 Web:wivw.sjgov.org/ehd 12� of each mon#IZ <br /> �� PERMITISERMCES <br /> SEPTAGE CLIEANER'$ REPORT <br /> Company Name: p,.�� J�`�S ;� <br /> / Report for the nth of: A'07 year ORA/7 <br /> Company Address: - i?O! /�o ce,r Ro/����s� Signature: <br /> Wrect Address�0 •�� O <br /> City Zip Code <br /> All Frrlormation submitted must be complete, accurate, and legible <br /> DATE MAME OF BUSINESS OR <br /> PUMPED PROPERTY OVVMER ADDRESS WHERE WORK WAS DONE GALLONS IRI RESIDE <br /> {G) Gr'rA TR L NAME OF TREATMENT <br /> U PLEASE INCLUDE STREET k, DIRECTION, STREET NAME AND CITY PUMPED FACILITY <br /> � � /w'� {C) CHEMICAL <br /> W (I <br /> W may. /� « <br /> at <br /> 3Ss I�Z <br /> -�7 Com, .� /. <br /> c?a SI <br /> ,. / rac <br /> Q ['a.�►%► S- <br /> CR <br /> 50� �" �•�•7`L,v t Cil �� 7v� �, �. _ <br /> •3o Yss� vim, qIeg Y s e0j.,,- AY <br /> rew �.4 cit TO 7 <br /> JJ / � <br /> /4/ city 4WL v <br /> M14 4YR <br /> 7 .o <br /> 7 Liv-s <br /> �6 C y <br /> 04 CA <br /> �JG 0• �'K�t d�Gv � <br /> Lo , <br /> city <br /> • '� <br /> City <br /> X490 L <br /> m <br /> ca � <br /> m ca <br /> 04 a <br /> CD Page of <br /> EHD 42-04 <br /> C4 12/27113 <br /> m SEPTAGE CLEANERS REPORT � <br />