Laserfiche WebLink
• n, � - SAN JOAQUIN COUNTY �� ,�✓� J • <br /> s ENVIRONMENTAL HEALTH DEPARTMENT �� turn this form by <br /> 600 East Main Street, Stockton,CA 95202-2708 . LIJ� <br /> 12'hof each month <br /> Telephone:(209)468-3420 Fax'(209)464-0138 Web:www.sjgov.Q g/e hd Il uL� <br /> °4`�fi°R��,: • SEPTAGE CLEANER'S REPORTp NOV 4 <br /> i <br /> Calinpany Name: / Rep' rt for t � yea <br /> p <br /> Company Address: Sign tore• MRS <br /> I <br /> r. `-Stmet-Ad&Fss City Zip Code <br /> Ail information submitted must be cam tete, accurate, and legible i <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS (R) RESIDENTIAL NAME OF TREATMENT <br /> PUMPED PROPERTY OWNERPUMPED (G) GREASE TRAP FACILITY <br /> PLEASE INCLUDE STREET H, DIRECTION, STREET NAME AND CITY (C) CHEMICAL <br /> city t <br /> r 1 /`--4 qqcat CA. 70� <br /> �� J� i>>✓/� �.' � �{ fes� '� c, �/ �� '' /�� �� �' <br /> -G5!0 i . „i•, q cit <br /> z ,et CI ! <br /> E- <br /> city C StA. r <br /> 3 I a . <br /> le <br /> vy is K. In ju, a G Ci .a t < <br /> lcce2or <br /> nf G Ci 7W. <br /> A <br /> • cit / <br /> / t <br /> city .✓ � �i;. 7��f/ G /' <br /> L,,- 1A0vv /,z cit G�( �L°b Z <br /> EHD 42-04 �� SeptidCesspooi Report <br />