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N <br /> t ' <br /> t <br /> W <br /> PA San Joaquin Public Heatth Services : r <br /> :NT^�l_��� lZeport for the month of 1 �Cl Y 2-0 i 3 <br /> Emrironmental Health Services <br /> PO Box 2009("S M.San Joaquin St.) Septic Tank and`Cesspoot Submitted by: .SP G 11�c, <br /> Stockton,Caiftnia,9S209 Cleaners Report <br /> Fax:4540138 Address: 10S93 S ArrDor' Way � <br /> Must be submitted by the 12"'of each month <br /> 0 <br /> Ln 0 <br /> cf) Date Name of Property OwneOAC, M OQ C641 r Address where work was performed type waste gal, pumped disposal site <br /> CO _ <br /> -a <br /> WauS — se, Zro <br /> o slafo Ll it fi d <br /> N <br /> z 5TH- R <br /> 4es <br /> c7 u <br /> 1 <br /> PICAI, q� ti V (100 h <br /> 2 - t k 12-0C) L 4 <br /> S u 00, <br /> H �-�S � 1M <br /> ,Z{Z- 04-1"3 <br /> w pU <br /> ' A Ssty— ca S 7�3 � <br /> T O E -t`{ L 5t' S gS20s tt t00c <br /> t <br /> Cl 2�Dt 7 t 4 I\ tc r <br /> s-bikni <br /> [is <br /> i1 <br /> 5?.�3 ee C. Loy, '- \MA cL <br /> 1 �'y �isZiS' t�e5 i(o()i) <br /> Crl � 567SRA J1 Eislog it it li it � <br /> The fb1lowing excerpt from the code of Federal Regulations.Section 403 "Report must be signed b <br /> Po gne y a corporate officer who can legapy bind the <br /> compa ny" F- <br /> 1 <br /> 1 certify under pena4 of taw that this document and ah attachments were prepared under i y direction or supervision. <br /> eX0 <br />