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ENVIRONMENTAL HED'TH DEPARTMENT l/ Return this " <br /> 600 East Main Street,Stc n, CA 95202-2708 <br /> the 12'h of eN _,in <br /> i. Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> CHEMICAL TOILET CLEANERS REPORT <br /> Company Name: s� ��� .40s' Report for the month of: ^l � �i.S year_ <br /> Company Address: C?1`Lx Signature: �' 7_ it 7 ,20j <br /> Street Address City Zip Code <br /> All information submitted must be complete, accurate and legible <br /> TOTAL NUMBER OF TOTAL VOLUME OF <br /> DATE CITY WHERE PUMPED CHEMICAL TOTAL <br /> TOILETS CHEMICAL TOILET WASTE NAME OF TREATMENT FACILITY <br /> PUMPED TOILETS ARE LOCATED PUMPED IN SPECIFIED PUMPED PER CITY PER DATE WHERE CHEMICAL TOILET WASTE DISPOSEI <br /> CITY PER DATE <br /> �- i N X51 AK '-Bc�; 2-W <br /> t k f.R, 4 <br /> 2- 16_1 it t 41� <br /> b R)0 <br /> D OL <br /> 246 <br /> 1Y 0)e x/e 1L PollelZD' S n c'J ��SZ7 <br /> 3'Z tc/ b em Z� <br /> 4-1- I y "„ST— eca&' <br /> • /D - !� c� lam`+ l ��� �'z .� <br /> 1-14 Ai <br /> rss Ste` <br /> �. AV) <br /> .r"vi.e 2tS 57) <br /> EHD 42.017 <br /> 9/23!2004 Chemical Toilet Report <br />