Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> JF6 <br /> ENVIRONMENTAL HEALTH DEPARTMENT Return this for b- <br /> 600 East Main Street, Stockton,CA 95202-2708 the 12thof eaiA monthTelephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> SEPTA E CLEANER'S REPORT �G <br /> Company Name: Rep rt for the th of: yez)x�, <br /> Company Address: j� Sig �ature:I ' <br /> Street Address City Zip Code <br /> All information submitted Faust he com fete, accurate, and le ible <br /> DATE NAME OF SUStNESS OR r (R) RESIDENTIAL <br /> ADDRESS WHERE WORK WAS DONE GALLONS NAME OF..TREATMENT <br /> PUMPED PROPERTY OWNER PUMPED (G) GREASE TRAP .FACILITY <br /> PLEASE -INCLUDE STREET N, DIRECTION, STREET NAME AND CITY ' (C) CHEMICAL <br /> 1 , <br /> citv 5 r4 nalT-Ql <br /> oj&p_,t_ in Ci --j / 6� - <br /> 7 <br /> ��—d�-f S��G d�•tJ �;� .////'!!!///�/I fy'�' <br /> city <br /> city <br /> Cdr <br /> 7124 cit C15-60 <br /> /� ! L� <br /> L 1; o <br /> Cit <br /> (7 CF 6 _ Pd cit I,. <br /> SZA L166 <br /> -09 1 z�Q ci / 10 <br /> 8 Ci , <br /> S, <br /> a <br /> r' <br /> Cit <br /> Ciry <br /> Cit <br /> t ; 4 <br /> F Cit <br /> city <br /> Cityi� <br /> r � I <br /> EHD 42-04 <br /> --------- Septic/Cesspool Report <br />