Laserfiche WebLink
SAN JOAQUIN PUBLIC HEALTH OERVICES <br /> SEPTIC TANK AND CESSPOOL CLEANERS REPORT <br /> V r a <br /> REPORT F&} TF+& MONTH OF-(% i 19 SUBMITTEO BY jft _ADDRESS d�✓ <br /> NAME OF ADDRESS WHERE GALLONS <br /> DATE PROPERTY OWNER WORK WAS DONE PUMPED WHERE GLEANINGS WERE UNLOADED <br /> l Gt.t, Clx�� _ �v "�► o <br /> r l ry�") <br /> 77 2'-TCA c <br /> iL) L ' S LICK r r '(t,i O <br /> a JVCtti� '�" TJ<<CL <br /> TUkY-- v <br /> �lel 12Citta, <br /> 6Uat,2 IL <br /> a <br /> �/�n Lai <br /> CVZ417 <br /> Lod <br /> Lo <br /> Return by the 12th of the month to I certify under penalty of perjury that the foregoing is true and cor <br /> San Joaquin Local Health District <br /> 1601 East Hazelton Avenue <br /> Stockton, CA 95205 UAfL SIGNATURE OF APPLICANT <br /> EH 05 39 Rev. 5/82 <br />