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SAN JOAQUIN PUBLIC HEALTH :;ERVICES ' <br /> SEPTIC TANK AND CESSPOOL CLEANERS REPORT <br /> REPQRT FOk"T* MONTH OFz - 19 SUB <br /> �oITIED BY �%�'� ADDRESS 3 2-4f <br /> NAME OF ADDRESS WHERE GALLONS <br /> DATE PROPERTY OWNER WORK WAS DONE PUMPED WHERE CLEANINGS WERE UNLOADED <br /> V2--1,Y (� <br /> C/ rat- L� <br /> ` r <br /> 0o • $rG <br /> v (; <br /> Ito <br /> _ Gd <br /> 7(-LLLL 2 0 <br /> L'r ( <br /> ,1 C <br /> b <br /> b d <br /> TO <br /> 17S <br /> x <br /> M 1� <br /> �k n r11 K, lk�rdo d <br /> g <br /> Return by the 12th of the month to I certify under penalty of perjury that the 'fbregoing is true and cor• <br /> San Joaquin Local Health District <br /> 1601 East Hazelton Avenue r <br /> Stockton, CA 95205 '—� <br /> EH 05 39 Rev. 5182 <br />