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Sa loa In Public Health Seryices _r <br /> 4tlyironmentalIpalt Se�LLj Report for the month of <br /> PO Box 2009(44S N.San Joaquin St.) Septic Tank and Cesspool Submitted byC <br /> Stockton, California,95209 Cleaners Report ; <br /> Pax:4640138 <br /> Must be submitted by the 12"'of each month Address: DSS S <br /> C) Date Name of Pro ert Owner <br /> p Y Address where work was performed type waste gal.pumped disposal site <br /> (�� �f ¢ <br /> -[[ J cam, szdL re c�t'e�. r z�so t <br /> C�lv rJ <br /> lef FC-1 — SZ3 ?fid (L r. <br /> Av (�Yzul tLLEA <br /> v�sl ,i <br /> 1 <br /> F( it k <br /> 10 �t <br /> Ui <br /> 10 0- <br /> ry <br /> S 2¢1 z <br /> U <br /> � (7Da <i a <br /> ' ac it tt <br /> The following excerpt from the code of Federal Regulatlons,Section 403 "Report must be signed a corporate o �[ <br /> company" Y p officer who can legally bind the ; <br /> I certify under penalty of law that this document and all attachments were prepared under my direction or supervision. <br /> v <br /> CL <br /> 0 <br /> Q <br />