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RECEIVED <br /> - <br /> ?' SAN JOAQUIN COUNyy <br /> m 'r Nl, 9 15 ENVIRONMENTAL HEALTH DEPARTMENT <br /> Return this form by the <br /> 1868 East Hazelton Avenue, Stockton, CA 95206-6232 <br /> ENVIRONM``�`_-AL Hit_A1 p11one: (20D)46B-3420 Fax.- (209)464-0'138 Web:Mimi.sigov,orglehd �2t' of each month <br /> PERMIT/SERVICES <br /> SEPT AGE -0CLEANEITS REPORT <br /> Company Ranke: <br /> Company Address: ?O/ o a•, � Report for the m h of <br /> el <br /> Street Address cis 'ems ® �4. ��3s� Signature: <br /> Y <br /> All informZip Code <br /> ation submitted must be CDm lete, accurate, and le ible <br /> DATE NAME OF BUSINESS OR <br /> PUMPED PROPERTY OWNER ADDRESS WHERE WORK WAS DONE GALLONS (R) RE2I17ENTIAL <br /> PLEASE INCLUDE STREET R. aiRECT104J, STREET NAAIE AND cITY PUMPED (G} cRfaseTp NAU E OF TREATMENT <br /> /J ( } CHEneCAL FACILITY <br /> H 4? C9 -, A c <br /> Ci L �r,� i Q <br /> Ld / 7 t <br /> J <br /> ry <br /> 0 <br /> n <br /> Q my <br /> r �-! _ Cit Ss� / <br /> _ C_O <br /> 00 _ <br /> < City <br /> Gil <br /> Ci <br /> rn <br /> Cil � <br /> CIIY o <br /> Cit <br /> r` r� <br /> CV � <br /> V Ci <br /> m �- <br /> [7 <br /> N CI 1 <br /> to <br /> CTI <br /> CD �. o <br /> (V c� <br /> I <br /> Cil � <br /> N <br /> C14 Ci > <br /> t� z <br /> LLT <br /> G) <br /> cn �— <br /> CT) Page D( <br /> CSD END 42-94 <br /> 1M7113 <br /> U <br /> r+ SEPTAGE CLEANERS REPORT a <br />%%E <br /> ■ ■ ■■■ <br />