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N //' <br /> y <br /> JAN 0 8 .2016 111�V••1 <br /> WLNVIRUNMENTAL HEALTH <br /> San J2muln Public Health Services PERETI9l RVICESEavi ! <br /> P4 Report for the month of �it <br /> GV <br /> PO Bo©c 2009(445 N.San kmprin St.) Septic Tank and Cesspool Subml ed by- <br /> , <br /> Stockton,CaEfi mLE 95ZO9 Cleaners Rep <br /> Fa)c 4WI38 <br /> Must be submitted by the 12th of each month -Addre!m t6 t <br /> rn <br /> o Date Name of Property Owner Address where work was firmed tWe waste <br /> "' 2= Maf 981-pumped disposal site <br /> tk <br /> CO S - rPG1600 <br /> rn 0L �Z 2 !tee ct it <br /> 6re sic <br /> o <br /> 2,X33 a '�O <br /> o 61-z0 • - � 2OU k w <br /> 950 <br /> 2,06 <br /> C) <br /> {5KQ 520 <br /> o <br /> , , ct 4, <br /> ��= r <br /> q <2Q o;Owtjoi <br /> Sao LUl <br /> 7 <br /> Ina <br /> 15 -7is Sfi <br /> t1C 6 e <br /> — MiLdli <br /> The fDUa C�r l l (' <br /> wing excerpt from code of Federal Regulations.Section 403"Report must be <br /> convaW signed by a corporate officer who can legal,bind the <br /> 0 1 certify under penatty of law that this document and an attachments were <br /> N pared under my diredbn or sceper*ion. <br /> CIO <br /> ti <br />