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SAN JOAQUIN COUNTl' <br /> m BNvT[LONMbNTAL HEALTH DEPARTi FENT Rety rn this form by <br /> 304 East\Heber Avenuc,Y4 Floor, Stockton,CA 95202-2708 the 12a'of each month <br /> . m <br /> � Telephone:(209)468-3420 Fax-:(209)464-0138 (T'efi:wwtv.sjgov_org/ehd <br /> u _ SEPTAGE CLEANER'S RK'PORT / <br /> a_ G <br /> 62 <br /> Company Nfaue: C & G portable Toilets, Inc. Report for the m& (1) of: // JJ r <br /> P.O. Box 1523 Signature: 1��1 -2— �h �j 7-VCompany Address: Riverbank, CA 95367 Zipr�&� <br /> All jIIfar[nR(lan sutlmi(ted must bt corn iletc) pecura(e rud le ibis <br /> (R) Fg-slurNruL <br /> O DAT! NAME OF RUS3JtESS OR ADDRESS WHERE WORK WAS DONE GALLONS (V) CRF-isr RAr ir"IB OFTRRA1MEN-f <br /> + 1'UNSPHD PROPER-r1•OwNFUL p[_EASC 1RCLUOC STRrE'c A, 1)[RECTIOK, STRUTT KAto ArU CITY PUMPED (C) CHCA(ICAi TACT[tTY <br /> N z <br /> � a <br /> LLJ <br /> � _ 40an <br /> O J <br /> p < 11 <br /> Ctiq-_ - <br /> N Ld Cih <br /> - I -Z <br /> City <br /> L 1 'S city <br /> w <br /> p (St„nzj <br /> city <br /> j p-4 CitY <br /> City . <br /> 0 <br /> N Clay , <br /> L m' 2 �r L o <br /> IL <br /> f r <br /> a — r l � A Y✓ <br /> oa v Q O <br /> u © h - o <br /> Q m <br /> Cry _ n <br /> Ln City _ -- <br /> m [— <br /> m Cily <br /> co City > <br /> CSD RIM 42-04 <br /> 8130104 ��l <br />