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#13 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTFI DEPARTMENT Return this form by the <br /> EN 1JU <br /> 600 East Main Street,Stockton,CA 95202-3029 12th of each month <br /> Telephone:(209)458-3420 Fax:(209)464-0138 Webs www.sjgov.org/ hd� TE _ ^ <br /> SEPTAGE CLEANER'S REPORT `J <br /> Company Name: revs Cle' C - Report for the month of.- ear _2 44q <br /> m, Company Address: Q 450 �6 a CAS CA 93 �� Signature: � S <br /><=> Sheet Address Cly 7Jp Code <br /> z All information submitted ,Aust be complete, accurate and legible <br /> tR? ReslnElrsAL <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS NAME OF TREATMENT <br /> PUMPED PrtOPERTYOWNERPUMPED (G) MA"TRAP FACILITY <br /> PLEASE INCLUDE STREET A. DiREcTlatl, STREET NAME AND CITY (cl CWMICAL <br /> L 4A Sa3 � <br /> illo v s UZ c U C SZ 3� <br /> 3 0I c n nu ._ ry I anc L 4 CRY A 2 <br /> f <br /> C un Go Z l w v '— H � cA 9s2 <br /> S t 4U R T-%I an 2-1 cv t c-1 c u 4C °fS <br /> 7109i L C AQV VAnc GG2 [ W , H wvc)14o cl y <br /> d c az c RO o' 52 o <br /> C-13z <br /> v [ uU , tau `- c o �s2 <br /> lr Uu QTS r t I Uj n E <br /> i v9 r s Z N o Cfl s <br /> 16 9 j do v t(A cKyo <br /> c.401J CAqS234/Z-15 <br /> � St C c 0 5 <br /> _"f j7cjtjt�il I- I W -w L CK - a cP� s © <br /> / ' rU d t �c f oZ w L- ci 4o C s-: <br /> Cy, 1 �'s1u (JZ QJ A CIS73 <br /> o w <br /> CHD 42-04 SEPTAGE CLEANERS REPORT <br /> 19MV <br /> - I <br /> --- -- . ....— — --- ----- <br />