Laserfiche WebLink
Xr i <br /> tl ' <br /> SAN JOA UIN COUNTY <br /> —, <br /> ENVIRONMENTAL HEALTH DEPARTMENT � y � Return this farm by <br /> 4- 600 East Main Street, Stockton,CA 95202-2708 <br /> �� � � the 12"'of each month <br /> APR 2�OB Telephone:(209)468-3420 Fara: (209)464-0138 Web:www-sjgo'orglehd 6 <br /> 7RORa`p <br /> ENVIRIO .;+ JIT !-HEALTH SEPTAGE CLEANER'S REPORT � " <br /> Company NamePERNA1 Report the month.of: ►NUJLL \ year <br /> Company Address: 00�0�`1 C- W An c�iOCl Q_ a Signature- <br /> Street Address 3� city Zip Code <br /> All information submitted must he complete, accurate, and legible <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE. � GALLONS RESIDENTIAL NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER t PUMPED (G) GREASE TRAP FACILITY <br /> •• PLEASE INCLUDE STREET H, DIRECTION, STREET NAME AND CI.S'Y C CHEMICAL <br /> F <br /> cin. i <br /> w <br /> JC 4 4f6vaola Ci �i706 <br /> t <br /> K Lc Z Cit C <br /> Cit �3­7 ?` <br /> -0 J.s- 0 6 Ci ly p !t/ <br /> city ra <br /> �- � j�' <br /> €, <br /> $ Cit O zoo( <br /> nrl 41A, .b city <br /> ..I fi= <br /> city 64 <br /> City <br /> cit / G � �Dd S'. ...�/ <br /> „ ... <br /> 2 l 4'2 ,E' cit s T <br /> 5 ci 19 <br /> neo <br /> a � <br /> a cit T� �t <br /> E!T 42-04 1` [ Septicicesspoo3 Report <br />