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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue,Stockton, CA 95205-6232 Realm this form 12'"of each month h the <br /> Telephone:(209)468-3420 FeDc(209)464-0138 Web:wlvw.sjgov.oig/eho <br /> C SEPTAGE CLEANER'S REPORT <br /> Company Name: � C S {�'� --{{-- <br /> Report for the month of: cl1 year 20 Z <br /> slre2 <br /> Company Address: e In co U'1�4n q52*azAaareaP cmc aP cmc Signature: <br /> All information aubmitted must be eom late accurate and legible <br /> DATE NANO OFE OR ADDRESS WHERE WORN WAS DONE GALLONS 90 REeNBlnSL <br /> PUMPED PROPERTYTY OWNER NAME OF TREATMENT <br /> PLEASE INCLUDE STREET 1, aIna.rio R, STREET NAME AND CITY PUMPED l01 oREAW rngP PACHM <br /> 07/0, PLEASE <br /> 2 6Daddk 0d l DRRaG <br /> 07/or. 412 lU. <br /> o <br /> Q CD Char <br /> 07 9car 2 000 C <br /> 07 6 000 C <br /> 076 Off 'Al 1 0 <br /> 07 5 + m c0 <br /> e I <br /> p7 bl 0 <br /> or od; 1,500 <br /> 20 <br /> Moines e <br /> eT/ C <br /> YYric1n SS o I <br /> ss <br /> a <br /> WN Ka 0 500 R <br /> EHp 3201 <br /> 1IXgm1 <br /> eEPTADE CLEMa:Ra REPORT <br />