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SAN JOAQU[N COUNTY IT- <br /> i ... <br /> "loz � � ll 1 <br /> y ENVIRONMENTAL HEALTH DEPARTMENT �L� 1I eturn this form by i <br /> < 600 East Main Street, Stockton,CA 95202-2708 �, the 12'"of each month <br /> • Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.orglehd a k <br /> s4. JUN 0 3 2008 l <br /> �` 611611 SEPTAGE CLEANER'S REPORT - lVVAD €�� f�.. DR <br /> } <br /> Company Name: 1'W V 1'1 a Repgrt for theRifi7� year <br /> I ' } <br /> Company Address: Signature: <br /> Street Address � City Zip EN1'N!'ri'�°���{ <br /> All information submitted must be Com lete, accurate, and legible <br /> �r IiiP.+��iL <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS (R) RESIDENTIAL NAMEOF TREATMENT <br /> PROPERTY OWNER PUMPED (G) GREASE TRAP FACILITY <br /> PUMPED <br /> PLEASE I;NCLVDE STREET 11, DIRECTION, STREET NAME AND CITJ (C) CHEMICAL <br /> 71- <br /> ci �I o00 7 <br /> a 9,q city 2 z eie,k C� yt�/ <br /> r' 1 cityS 00 <br /> city <br /> .i <br /> t Ci �i C $� o a aC�i <br /> Ali Ci O S7A 7"X/_ <br /> tr <br /> Q Ci 5"MCkap 00a /v- <br /> v <br /> city 112mclewou 711, <br /> S + MfePoer 153M ;I— <br /> Ci ( , <br /> -7 e. Uz. <br /> rso � fl City 7 <br /> G" <br /> IF � <br /> G s d7 cityC z <br /> ws A, City ',Q t� W. <br /> f o r i hi C; l�A 2.67on 97ot <br /> d, cit 0 <br /> s <br /> -2 _0 8 w dl}, vuQ Cit 'T d A S ' <br /> p .i <br /> P Z Q 6 cit GZA41301V <br /> Septic/Cesspool Report <br />