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SAN JOAQUIN LOCAL HEALTH DISTRICT YYIln56bn 1=07,e4,Prl5E' i <br /> SEPTIC TANK AND CESSPOOL CLEANERS REPORT <br /> REPORT' Ff}k TIME MONTH OF _` � SUBMITTED BY /¢ /L./ ADDRESS— -a g 33 -67-17 <br /> NAME OF ADDRESS WHERE GALLONS <br /> DATE. PROPERTY OWNER WORK WAS DONE PUMPED THERE GLEANINGS WERE UNLOADED ! <br /> [Y [ <br /> 42 <br /> 41 <br /> S . <br /> r• //V//{7 qS� <br /> } <br /> 0 <br /> " I <br /> G C7 j <br /> n OCY(A inn C, q vu�y I certify under penalty of perjury that foregoing is true an correct. <br /> fVtl� Ramet��a/� t/-eAGfA i <br /> 7n avn, -- G _ P <br /> 6 DATE <br /> av �a•at ��'10�''La a elate 1 goo <br /> g536/ - <br /> Rol 3-Y7-aY09 <br />