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SAN JOAQUIN COUNTY <br /> r' ENVIRONMENTAL.HEALTH DEPARTMENT Return this form by the <br /> 600 East Alain Street,Stockton, CA 95202-3429nt�1th of each month <br /> Telephone:(289)466-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> f F•••P y SEPTAGE ChEANEWS REPORT u <br /> Company Name: <br /> Report forthe month of: year ZQo9 <br /> m Campa'ny Address: .60 D � � ?371z- Signature: ` a yr S' <br /> o Skeet Address CAW ZIp Code <br /> CD A11 Information submitted must be complete, accurate and legible <br /> z <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS tRf RESIVER L NAMEOF7�REAT]M@�iT <br /> PUMPED PROPERTY OWNER PUMPED [Gi CREA8ETRAP FACiUTY <br /> PLEA82 INCLUDE STREET ii, nIREC7loN, STREET RAMS AHO CITY �, <br /> CHMMAL <br /> 3 1-ow c car• ' Q Gt/ 110 <br /> C ULj <br /> 1- �U G 6 U s UJ C Olt" eA 7SySZ /5'- <br /> 261 a /60 .2 W vmYO <br /> A0110 el C/ / w C ft #0 W CA �.3 d <br /> v Lc a rr4 V /60 w <br /> r n� II I G0Z u v c C A % � <br /> U \)( t ) •� c C 50 <br /> u t C c' g /5 <br /> za(0 C 23 5D <br /> L c. fs ICA Aa jkl= wil q c) C AqS,-z3L 3 <br /> o .�sH C4 HACAT735- <br /> - <br /> v is - <br /> V- Cfty C11C ' 4S` 5C� <br />`L < SZ3 <br /> 3 7 QL c -in 14 (A r4sZ51S <br /> o t � n c d 7 /6,p <br /> T c = i s S <br /> �S d (-A (457-3V <br /> FjiDo 2-04 <br /> 10A 7 <br /> i0f41C1 SEPTAGE CLEANERS REPORT <br />