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N RECEIVE® <br /> APR 0 3 2015 <br /> San Joaquin PuBCc Health Setvioes R rt far the month of <br /> ENVIRONMENTAL HEALTH �° t <br /> Q4 PO Box 2009(445 N.San Joaquin St.) Septic aRnk andCesspool Submitted by: A A <br /> Stockton,CaRfornia,95209 Cleaners Report ,----' <br /> Fasc 4&10138 -Address:-4_-3 S,, ltwrif <br /> Must be submitted by the 12"'of each month <br /> o Date Name of Property owner Address where work was performed type waste gal.pumped disposal site <br /> Z8 e �� h �Lic R s� a 5 Zl s re �c�c�o <br /> �' Q524,03 3 N �fof e Uns-h �a5 -:Oje ZD5 side trtQL Z�UO tt u <br /> 0 <br /> N { e `� 'i52-1,[ )& z� <br /> _ r 27 0(4b g5ZD <br /> a 25231 ( - �L N <br /> F–" QSZ�O [00p t� u <br /> 0 v Aver S u <br /> S 7 - t-eaSe 2-DO <br /> U <br /> a r , ' 0 L iv f K–q5 S �-L c t z <br /> -� it �57fD124t� cr <br /> 3 " i <br /> - A ,Z S� 1�ZD 7 `� � `r <br /> TTI 74 �#' CYN <br /> 7 ': B tW 12-00 <br /> Ida Reo g Zit - <br /> 2-D0 o <br /> �o <br /> t� a <br /> The kWming excerpt from the code of Federal Regul.Wrns 443"Re{aort must be signed tpy a corporate i <br /> te n , rporate officer who can legally Wnd the Q <br /> 0 l certify under penalty of"that this document and a"attachments were e <br /> o pared under my directifln or sty3eiviswn. <br /> O > <br /> a " <br /> 0 ■ 0 ■ 0 <br />