Laserfiche WebLink
f <br /> SAN JOAQUIN COUNTY <br /> J,: ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT Return this form by <br /> 4 <br /> 600 East Main Street, Stockton,CA 95202-2708 the 12`h of each month <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd SEPTAGE CLEANER'S REPORT <br /> Company Name• Report for the month o ye <br /> l is <br /> Company Address: Signature: l' <br /> Street Address L City Zip Code <br /> All information submitted must be complete, accurate, and legible l <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS (R) RESIDENTIAL NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER I PUMPED (G) GREASE TRAP FACILITY <br /> PLEASE INCLUDE STREET H, DIRECTION, STREET NAME AND CITY (C) CHEMICAL <br /> Pn.Pr I la ci t 000 <br /> 0' e-WADOW AAXE. dwy qq Ci <br /> OG 6 <br /> �- Lbt� ©© City e 6 c . <br /> 3- $ 1,D av A <br /> f <br /> a city <br /> 1 <br /> Le-z naihn P Ci t X A0 2sob <br /> •7 -10 0 cit a <br /> Ci <br /> Cit <br /> City <br /> o <br /> cit <br /> 1 <br /> City <br /> City <br /> Cit <br /> cit <br /> i <br /> city <br /> city <br /> Cit <br /> EFID 42-04 Septic/Cesspool Report <br />