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E"CEIVED <br /> DeK, <br /> MAY 0 2 2017 SAN JOAQUIN COUNTY <br /> ENvIRONMENTAL HEALTH DEPARTMENT Return this form by the <br /> ENVIRON,MENIALHEALT 1866 East HazeEton Avenue, Stockton, CA 95205-6232 92u' of each month <br /> PERMR/SERM-ES Iefephone: (209) 46&3420 Fax:(209)464-09 38 Web:VMV.sjgov.orglehd <br /> SEPT GE CLEANER`S REPORT <br /> Company Name: Report for the triohof: year <br /> Company Address: Z-Y2S�� ignatore: <br /> SUeet Addrefs City Z6Goe <br /> All Information submitted must be complete, accurate, and legible <br /> DATE NAME OF BUSINESS OR (R) REziDENnrL(G) GREASEIRAP <br /> PUMPED PROPERTY OWNER PUMP 1) NAME OF TREATMENT <br /> PLEASE INCLUDE STREET R, DIRECTIOtJ, STREET NAME AKD CITY (C CHEMICAL FAGlL <br /> FTY <br /> IfA -S'�< < z �o F� <br /> u ' ciiy 14 ( Uu ti s <br /> �( / d P cw t i it 4 <br /> 4 cfLy it p 1 4 <br /> cit <br /> ' CO L <br /> C. _ <br /> b � <br /> IL t u <br /> q 3 CLt <br /> C--1u <br /> rs Y <br /> �- crt LS G <br /> cryC� <br /> r0 city <br /> C �— <br /> Page of <br /> EHD 42-04 <br /> 11027115 Sir°TAC-E CLEANERS REPORT <br />