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RECEIVED <br /> a��IK MAR 01.6 2014 <br /> _�''�� �'O� SAN JOAQUIN'COUNTY <br /> ENVIRONMENTAL HEALTH <br /> ENVIRONMENTAL HEALTH DEPARTMENT Return this form by the <br /> PERMIT/SERVICES 1866 East Hazelton Avenue, Stockton, CA 95205-6232 12ffi Of each month <br /> Telephone: (209)468-3420 Fax: (209)464-M3B Web:wwt-r.sjgov.org/ehd <br /> S PTAGE CLEANER'S REPORT <br /> Company Name: C � `lp-" Report for r� <br /> p he m nth of: year d <br /> Company Address: (� ( �� ✓?�_ <br /> Street Address ' tLire. <br /> Ctrs' Zip Code <br /> All Information submitted must be Complete, accurate and ie ibie <br /> RATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS R P�slueranAL NAME OF TREATMENT <br /> PUMPED P OPERTYOWNER PUMPED (G) GREASETRAP FACILITY <br /> PLEASE INCLUDE STREET E, DIRECTION, STREET NAME AND CITY {C} CHES9CAL <br /> aCi � <br /> In;-7 6 0 t_ l <br /> c. d t L-1 t <br /> lip city tt ! f cc <br /> c``A C <br /> ,a l (PLOUG- LL <br /> •� 6 cit <br /> 3 ca ,QrJ t L k <br /> 0 <br /> cit <br /> City <br /> 0 <br /> C; <br /> I <br /> C it <br /> 0 <br /> 1 <br /> Cit <br /> City � <br /> C- a <br /> E <br /> C' <br /> Page of a <br /> EHD 42-04 — <br /> 12/27/13 SEPTACE CLEANERS REPORT <br /> r�- <br />■ ■ ■ ■ ■ <br />