Laserfiche WebLink
�,n E SAN JOAQUIN COUNTY t HEC EKED <br /> i ENVIRONMENTAL HEALTH DEPARTMENT Return 11 Return this form by <br /> < 600 East Main Street, Stockton,CA 95202-2708 • ,'! the 12te of each month <br /> 5 Tetilephone:(209)468-3420 Fax:(209)464-0138 Web:www.Sjgov.org/ehd OCT 0 8 2009 <br /> • IFOR�`p• ' <br /> Y SEPTAGE CLEANER'S REPORT ENVIRONMENT HEALTH <br /> SE { <br /> 1 P�RMIT( it <br /> Company N me: Report forte nth yea <br /> r Y w <br /> � �t1� � ���� Signature: j! <br /> Company Address: ��� _ <br /> Street Address city ' Zip Code }t I <br /> All information submitted must be com tete, accurate, and le ibte �1 <br /> DATE NAME OF BUSINESS ORIt ADDRESS WHERE WORK WAS DONE GALLONS (R) RUSmENT NAME OF TREATMENT <br /> 4. r, .'-. Al (G) GREASE TRAP <br /> PUMPED PROPERTY OWNER PLEASE INCLUDE STREET 4, DIRECTION, STREET NAME AND CITY PUMPED FACILITY <br /> (C) CHEMICAL - <br /> 1 ! <br /> cit CA ODD 1 <br /> p g _ AfWaqCite' - 0j00 ' <br /> ! �M 1 Cit .!, A 2-- � n- <br /> - Q P cit C. 1470 V n , <br /> city <br /> — ~-09 city <br /> ' I <br /> f 4 C <br /> Oc <br /> rU Ci S f I`d/. o S�' . <br /> C - ,l P t l 7QRon r1cp W'* <br /> -d 0 Ff1jj&4 q qci C Q :T d <br /> f <br /> .aQ 5 / Q cit `_` 004 d� 4 <br /> S citant C `�. <br /> a 1 a cit � 2 11. i i <br /> e <br /> 5 cit o �. <br /> EH 42_04 Septicicesspoo[Report I I <br />