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** PLEASE CHECK LOOKUP - if good, then Approve QCStatus, else update with correct RECORD_ID (2)
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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P
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PARKWOOD
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26434
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4200 – Liquid Waste Program
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PR0547168
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** PLEASE CHECK LOOKUP - if good, then Approve QCStatus, else update with correct RECORD_ID (2)
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Entry Properties
Last modified
5/2/2023 11:08:45 AM
Creation date
9/28/2021 1:42:27 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200 – Liquid Waste Program
RECORD_ID
PR0547168
PE
4244
FACILITY_ID
FA0026767
FACILITY_NAME
SEPTICO
STREET_NUMBER
26434
STREET_NAME
PARKWOOD
STREET_TYPE
DR
City
PIONEER
Zip
95666
CURRENT_STATUS
01
SITE_LOCATION
26434 PARKWOOD DR
P_LOCATION
98
QC Status
Approved
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SJGOV\sballwahn
Tags
EHD - Public
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�U .i <br /> .� SAN JOAQUIN COUNTY <br /> z' ENVIRONMENTAL HEALTH DEPARTMENT Return this form b the <br /> , . .a y <br /> ` 1868 East Hazelton Avenue , Stockton , CA 95205 -6232 12th of each month <br /> ��CN6 Telephone : ( 209 ) 468-3420 Fax: (209 ) 464- 0138 Web : www , sjgov. org /ehd <br /> SEPTAGE CLEANER ' S REPORT <br /> Company Name : C Cc <br /> Company Address : �- �- �r �, Report for the month of : a rluog< < year v'2 0 a <br /> I <br /> 13 1 ;(: r � er �5� l� Cv Signature : .���n.=-.� <br /> Street Address City Zip Code <br /> All information submitted must be complete , accurate , and legible <br /> Now <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS (R) RESIDENTIAL NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER PUMPED (Gj GREASE TRAP FACILITY <br /> ONEPLEASE INCLUDE STREET # , DIRECTION , STREET NAME AND CITY C CHEMICAL <br /> H P �o`� ® /(�� -� w cit l �e ® J` `W T <br /> AHP & 4 <br /> I /,, g Ale <br /> �j Cit Gq U fJ0 <br /> - r 0 P l lX [ /✓ • < <br /> CityAxo o CY 6) I P <br /> /U cit ✓� ea ��( / W � � 12 I� �l <br /> — L !`cls �6 M lel O A I � �"' Cit C9 / G' / (goo r2 � r2 � T <br /> o cit ( Poo <br /> tA I bcpop M tt cit c4 Cw;' 16040 <br /> 14 r '/ O ✓, fl000f H P t Coceo iv , / Pct <br /> Cit <br /> ft !' b c? !k tai lU I 14-CAO) VQ city lqcf !!N <br /> — 3 1 Al /y H l to 10 A wy ! ( cit <br /> 7 /� e iC, o� s 4: /06e /ICL 4 'de' cit 4C)COPOF <br /> Cit <br /> City <br /> city <br /> Cit <br /> Cit <br /> Cit <br /> Cit <br /> Cit <br /> EHD 42 -04 SEPTAGE CLEANERS REPORT <br /> 1014107 <br />
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