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ro <br /> San Joaquin Public Health Services Report for the mantth of o <br /> �- <br /> Q Wiromer W Health Serv€ces N <br /> —, PO Box 2009(445 N.San Joaquin St.) Septic Tank and Cesspool Submitted by: G _ o <br /> Stockton,California,95209 Cleaners Report <br /> Fax 4WI38 Address: 0 � <br /> 1ryoirf 1 0y, A Q <br /> Must be submitted bV the 12"'of each month � <br /> . w <br /> Date Name of Property Owner Address where work was performed type waste gal.pumped disposal site � <br /> 0 <br /> f�- 952Z7 �re� 1200 <br /> E_ Sf- Stv- 9 5 <br /> W 3 Mtlp 7T 5T x.5iaerrhaC, - 00 t, <br /> z 5 apt Q�c�5 it t( ! 2D << l n7 <br /> o co,Wl tze> pezzi IZA 5rk ci 5 L� �P U V LL tit H <br /> 80L q� �ers�a i ve ASttc Qs G <br /> - iia data � La.n X9.5240 <br /> _ <br /> _ _ <br /> l C� N1Q C A� L ct5 2E}57 "` it <br /> Rte Reic!t tb `"L G:rLMi 0 SZ�i reSic arti ,{ iL i. <br /> 10 0axi-0i ld Ave � 2�+0 v <br /> W"r-1 U7 Ca' S� `qS2 �� �� [(Poo � N <br /> 257 va400�0_R_ctS' cls ct [60 0 « <, <br /> S �- S t 20 0 r� w o <br /> 4 o S?a.2 0- <br /> it <br /> 2o4U2H3 lait 1A I 1< G <br /> -bl �1 it U w <br /> 1.1 <br /> E& C c? J Z!Z i t [l t if M <br /> 0 <br /> FC- <br /> The <br /> _Tine fti-kApant ing aacerpt fivrrt the <br /> corrapar►}f' carie of Federal Regulations.Section 403"Report must be signed by a corporate officer who can legally bind the <br /> certify under penalty of law that this document and all attaduhrertts were prepared urcler my dlnection or supeMsion. RECEIVED,, b <br /> — 1 SEP 0 2 201 , <br /> ENVIRONMENTAL14FA," <br /> PERM1PSERVICES <br /> N <br />