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600 East Main Street, Stockton, CA 95202-27081 <br /> the 12t1'of each month <br /> ;, P• Telephone: (209)468-3420 Frr_L:(209)464-0138 Web:www.sjgov.org/ehd <br /> �•+Fo't��s <br /> SIEPTAGE C1LEANE RlRE,PORT <br /> Company Name: /�yl <br /> l � • Report for the z o�tloyeaa <br /> SignCompany Address: i� _V ature: - <br /> Street Address City Zip Code <br /> All information submitted Inust be com p Ietc, accurate, and I 2 ible <br /> DATE NAME OF BUSINESS OR ADDRESS WITERE WORK WAS DONE GALLONS (R) RESIDENTIAL NAME OF TREATMENT <br /> PUPYIPED PROPERTY OWNER PUMPED (G) GREASE TRAM FACILITY <br /> PLEASEINCLUDE STREET' I!, DIRECTION, STILET NAME AND CITY (C) CnEmicm' <br /> Jc'(�. V c Citv ZX� <br /> ' 1 i�( ` �� �C: Cit, � <br /> f UncJl�G n I J J �' Sj <br /> City <br /> �IQ Cit, <br /> �U Y �- <br /> City <br /> �7zz �C . city �� <br /> - <br /> I cit• . <br /> City , <br /> M COLA- city C` <br /> N, C-5ctJ` Cit ti/r I 1� <br /> City t <br /> n <br /> r '�'' �' f �` ' 1�- �1 City •� 1 c�CJO l� ���i� <br /> (> �j�U &JzZC�l4C� Rcr'Ci1 City J 5000 <br /> Y, <br /> 1 cityt + <br /> Cit F— <br /> City ) <br /> 131-11)4-1-04 <br /> ----• Septic/Cesspool Report <br />