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SAN JOAQUIN CO UNI N' — <br /> CD J:NVIRUNMENI'I'AL HEAL-TH DEPARTAtI~WY Return this loan by <br /> 304 Fast Weber Av-uc,3'd Flour, Stockton,CA 95202-2708 (lie 12"of each month <br /> r <br /> Telephone:(2(19)466-3420 Fa-xi:(209) 464-0138 JI'eb:www.sjgov.orgle n <br /> v SEPTAGE CLEANER'S REPORT <br /> a <br /> Gr <br /> company Name; C & C Portable Toilets, Inc- Report for the mTO of: _ year <br /> P.O. Box 1523 / ! J <br /> CompanySignature �p"I' �'cc �r <br /> CompaAddress: <br /> Riverbank, CA 95367 �,� <br /> All Informalion submitted must be cam Ittc rccuratc xad le iblt <br /> (tt) R>LCIDClf17AL <br /> DATE NAME OF BUSIKES�OR ADDRESS JYHERE WORK WAS DONE GALLONS (G) cess TR.U' NAME OF TREATMEN <br /> O yUMPL'D PROPERTY OWNEIL rLEASE IKCLUDL STKECT M, DIRECTION, STRELT NAME AND CITY PD4tPED C) cstrnuGi FACILUrY <br /> N /anv �_Ctg Gam. <br /> Q <br /> CO _ 16JI, C ry <br /> CO <br /> < /� <br /> o z <br /> CU <br /> LJ �� c- <br /> \ t <br /> W City (� <br /> d - <br /> f 12 <br /> lv5 b t cit, 12 <br /> ,A G�, <br /> v <br /> n City <br /> o <br /> z5Z <br /> +) co city <br /> L m cn <br /> o -4 <br /> m <br /> IL <br /> Um L>ry <br /> a7! co .. <br /> U CN <br /> Lam. o <br /> cwt <br /> Ctly <br /> Q city <br /> O - --- - — —-— — <br /> Gty - --�-- O <br /> In cm <br /> LAID 42-0 a <br /> O ' 5130!04 <br /> 0 <br /> v 1 <br /> 0 <br />