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SAN JOAQUIN CjOUNTY °',�MOM <br /> ENVIRONMENTAL HEALTH DEPARTMENT eturn this form by <br /> 600 East Main Street, Stockton,CA 95202-2708 the 12'h of each month <br /> " Telephone.(209)468-3420 Fair(209)464-0138 Web:www.sjgov.org/ehd OCT 0 8 2009 <br /> 4ClFORe� ' <br /> SEPTA EANER'S REPORT ENVIRONMENT U11 { <br /> Company Name: Report for th yea <br /> Company Address: I Signature: <br /> tree[A dres city Zip ode <br /> All information submitted must be cam tete �aecurate, and legible %A <br /> .. <br /> DATE NAME OF BUSINESS OR t ADDRESS WHERE WORK WAS DANE kGALLONS (R) 'RESUIENTIAL NAME OF TREATMENT ' <br /> PUMPED PROPERTY OWNER I PUMPED (G) GREASE TRAP FACILITY! <br /> PLEASE INCLUDE STREET N, DIRECTION, STREET NAME AND CITY (C) CHEMICAL <br /> city <br /> M <br /> / <br /> f yI1/`�' /� ,rte <br /> • ' \ I ci . <br /> �- 6 i c. l 1 'f city 7 �o ,a <br /> L. k4n it t CiN 1 CA Z5__0 <br /> -e> 6 1c. c L^ 44 <br /> r <br /> Ci <br /> —7 23 Grnvi Cara) Rucii ! <br /> —Q City C 6A f C"D 0 Tai• <br /> 1 r Cit I C <br /> 1 d' n+ ci t /a 600 <br /> gg <br /> t n 6q A &I Lag i y C1q;z AJ Q <br /> C1 9 <br /> 1 <br /> ;47-0cl <br /> O 1 GI q 760 -7r,1111 Ci C <br /> `P ,C M. city C,4 P^omo } . <br /> City <br /> O itygEA7D 42 <br /> PCity 4 <br /> EHD 42-04 - +' Septic,/Cesspool Repoli <br />