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RECEIVED <br /> mSAN JOAQUM COUNT1' <br /> MAY 212014 RNMONWNTAL HEALTH DEPARTTIERT Return this form by <br /> m 304 Fast Weber Avcauc,3rd Floor, Stockton,CA 95202-2708 the 12`"of eacb month <br /> QENVIRONMENTAL HEAL?H Telephone:(209)468-3420 Fal.. (209)464-0138 Web:www.sjgov-org/chd <br /> pimMITISERVICES SEPTAGE CLEANER'S REPORT <br /> CompanyName: C & C Portable Toilets, Inc. Report forthem th of ye�� <br /> P.O. Box 1523 <br /> Company Address: <br /> Signature: %-/2 -QA —, D'[ :!l 2 V <br /> Riverbank, CA 95367 _ ZlPcade <br /> All iufnrraxllon submitted must be cornTete ■ccurrtc mad legible <br /> urnMCNTUL <br /> DATE KAME OF BUSIKESS OR ADDRESS WME WORK WAS DOTE GALLONS (R) cRrAsrTR <br /> (G) cti>=AssTwtr KAIE OI'TREATM£NT '- <br /> O <br /> z PUMPED PROFERTY OWNER PLEASE INCLUDG STREST If, DIRECTION, STREtT NAM AY.D CITY PDNWED (C) CSf uic FACILITY <br /> MM d t� D 3 <br /> w <br /> M s <br /> 10 J C"'W ¢ <br /> M Z -2/24/ <br /> p <br /> O z <br /> �, p <br /> �.� <br /> Z <br /> w Mc GL <br /> In G A 67 <br /> //- <br /> — (20 ' D C cin n) l� — <br /> N <br /> (3n• <br /> eO <br /> CD <br /> cls �. z <br /> L <br /> O m <br /> 1L v / city <br /> o <br /> LD <br /> rn <br /> IT <br /> Cz m c17 <br /> U N <br /> /Z o <br /> - nI <br /> A 9A <br /> m ' <br /> Cary - <br /> ,� cr <br /> Lf) <br /> Qom. -Lt9 \ > <br /> d I C) r <br /> i. m - <br /> O CN GIVm <br /> CC] <br /> C <br /> ay <br /> r, LID EUD 42-04 <br /> N 8/30/04 <br /> V <br /> n <br /> io <br /> F <br />