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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Rehlm this form by the <br /> �€ 1868 East Hazelton Avenue,Stoditon, CA 95205E232 12a of each month <br /> Telephorre:(209)468-3420 Far(209)464-0138 Web:www.sjgov.o <br /> /1 SEPTAGE CLEANER'S REPORT <br /> Company Name: �a� C SQ 'It L' <br /> Company Address: I1OR2 r l� Report for the month at Ay�yS�- year ZOZZ <br /> sl.� Cu,e /igflCn Lal'la 115(a343 Signature: <br /> °"v aD coda <br /> All information submitted must be cam late accurate, and le able <br /> DATE NAME OF BUSINESS OR <br /> PUMPED PROPERTY OWNER ADDRESS WHERE WORK WAS DONE GALLONS (R) ame,,mL NAME OF TREATMENT <br /> PLEAD' INCLUDE BTREIT DIR ECTIO.. sTREET NAME AND CITY PUMPED lel �au�ASE TNAP FACILITY <br /> �� 5•N. in r I l �ac4 raL IC k 3.500 (' <br /> N. W;Y r 18 1 o tK <br /> o$ 1 00 C <br /> NiN i 1i 79 Arwts+rOYlAZO( <br /> omm ifie 5cd35 Cherokee Rd c Cel` 1500 t2 <br /> & S W StDcu+on 11000 <br /> e s 4 Cre K d I <br /> 0$10 4 r " 1 5 V' L i 1,600 <br /> 08 ° <br /> ow N. ( oo r <br /> ° Qd a, Co 00 <br /> � It vers E o0 ovt 12d A cavrl 1 <br /> ifa S aVxA 53 r CCA a 1500 <br /> P 1177 N kani In, O (,-)Of i <br /> I o <br /> 06 C-7`7 1 goo IQ <br /> a111ThornforiI <br /> 7 1500 C <br /> a <br /> a <br /> ENDa2d. <br /> mW <br /> SEPIAGE CLElWFRd REPORT Ii <br />