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San Joaquin County Environmental Health Division <br /> iwa3a <br /> Septic Tank and Cesspool Cleaners Report_) HjL1y3H-TVIN NNOU a <br /> Company's Name: SRC Primping Co. nn <br /> Company's Address: 11350 Kiefer Blvd,Sacramento, Ca. 95830 {} 038 <br /> Report for the Month Of,* <br /> IIJ 'Gallons Where Cleanings t <br /> Date Name o Fra ert Owner Location Cir Pum ed Were Unloaded <br /> Ig 2 O <br /> J 4 233 Gow'' 2 r F � <br /> -0)' .l v r <br /> coo <br /> /4rz v ';L <br /> 72 ILI e�M!, wkl J7— <br /> obi �- <br /> ate , IJL) 0 <br /> -- <br /> V—A/ Return by the 12th of each month to: ' <br /> Date J Signature of Applicant Environmental Health Division i <br /> 304E. WeberSt., 3rd Floor <br /> Stockton, Ca. 9.5202 <br /> I <br />