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q <br /> [Ggv `�`�� <br /> /r. ��,.• .� � J SAN JOAQUIN COUNTY <br /> 4' ENVIRONMENTAL HEALTId DLPARTMENTRetAI•n this form by <br /> ur. <br /> 660 Last Main Street,Stockton,CA 95202-2708 the 12th of each month <br /> Telephone:(209)968-3420 Far:(209)464-0138 Web;www.Sjgo g/ehd <br /> SUN <br /> E�VIR�N'�ES�C x R��H onaMBORREEPTAGE CLEANER'S REPORT ENTERED <br /> cornphny Nart pjR ,Jj - RV. =98TEGNM <br /> CL 8R Report for the month 4 $JCV t year CF <br /> Company Address: F <br /> _ , <br /> 5frcct Addrea� City Sig aturc•Gip Cut1e <br /> All information submitted must be en m lete, accurate, and legible <br /> DATE NAME OF EUSINF.SN OR ADDRESS WHERE WORK WAS DONT: GALLONS 4R) RF.SInEN SIAL <br /> PLIMPEO PROPERTY OWNER RG1 CREASE FRAP NAME OF TREATM ENT <br /> N3 <br /> 1'LEASF INCLUDE �u'IREF;T tl, DIRECTION, STIt :ET NANIF. ARD CITY PUMPED FACILITY <br /> (t.0 (ti) CHEMICAL <br /> T <br /> Pity <br /> CCO <br /> N <br /> Cit <br /> Cit <br /> City <br /> Cit <br /> City <br /> City <br /> Cit <br /> City <br /> � o <br /> Cit <br /> R7 <br /> > City <br /> Uj <br /> City <br /> Cit <br /> 0 <br /> O <br /> 0 <br /> r cit <br /> z00 <br /> 0 <br /> (.0Cit <br /> b <br /> ZI <br /> ERD 42-04 <br /> ZI <br /> Septic/Cempnnl Repud <br />