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Septic Tknk and Cesspool Cleaners Report <br /> ` r\ <br /> CQWAN.Y SS: "OaD <br /> MONTH OF: ,, 2000 <br />`•_ .s 'TE <br /> OF 'ROPERTY yADDRESS WHERE WORK GALLONSRE CLEANINGS WERE UNLOADED <br /> ER WAS COMPLETED PUMPED <br /> F <br /> "Ojr 8 11 1114 <br /> Re)zZ,2At <br /> oa <br /> 4e <br /> a" a4r.D11VA- <br /> 6 <br /> v7 /161talor I j " <br /> &'mm,,, CAd nq parlhc 4ij, ion __;11 <br /> pi <br /> lQ r E <br /> �-� ��:� 185/� "6� C5 S c ✓✓ <br /> Tt4 <br /> er <br /> Return by the 12'of each m CIENED <br /> ;' I CERTIFY UNDER PENALTY PE Y T j.. FORGOING IS TRUE AND CORRECT. <br /> Environmental Health D' <br /> 304 East Weber Avenue,3'd Floor -0- <br /> Stockton, <br /> rte } <br /> Stockton,CA 95202FEB t 2008N' DATE -SIGNATURE OF APP�-ICANT <br /> Rev.12/99 <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES <br />