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600 East Main Street, Stockton,CA 95202-2708 II the 121h of each month'. <br /> W1�61 <br /> Telephone:(209)468-3420 Fru:(209)464-0138 Web:www.sjaov.org/ehd <br /> SEPTAGE C EANE 'S REPORT �1 <br /> Company Name: <br /> Report for the a h of: rar��/ <br /> l _ P y <br /> Company Address: �� Signature: - <br /> Street Address City Zip Code <br /> All information submitted must be com tete, accurate, and legible <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS (R) RESWENTLAL 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 /> Cit <br /> /Rq <br /> Ci <br /> I �_�Z� zz�� ace�PC i <br /> Y" �5w�_MI/ <br /> DW l //.^`)73 /V , LLd -3ac PH Cit <br /> y ni <br /> Iil �C T�CCit <br /> City )77 i9r— <br /> city — <br /> —D City 1 S <br /> 4 tel <br /> / ` ZQWe- cit - <br /> 1/) y <br /> S <br /> city /(1C <br /> r c, ��� city4 C <br /> City /t <br /> j` Cit !� <br /> 6 Cit /� <br /> 1 00T-P 113 � t L ue City <br /> i ' CS.( Cit 1 VC�J <br /> Cit <br /> to <br /> Gil 131 <br /> ' &a Cit UDD <br /> F 42-04 <br /> •-•-•---• Septic/Cesspool Report <br />