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- <br /> CB .� .r. two <br /> .a w <br /> San Joaquin County Environmental Health Div' ion <br /> �aSeptic Tank and Cesspool Cleaners Rr A_ <br /> T12210 <br /> ., <br /> Company's Name: SRC Pumping Co. <br /> �Iilyinywtw,- ALTH <br /> Company's Address: 11350 Kiefer Blvd,Sacramento, Crl: 95830 '� IGES <br /> t <br /> Report far the Month Of. �' /"- � U J� <br /> f <br /> C (;Gallons Where Cleanings <br /> Date Name o Pra ert Owner Location C� 'gym ed Were Unloaded <br /> LAI 11 U r r c <br /> r <br /> �• /!� lam/ m9�/ L.A) �r ; <br /> A/LA1r 1 r <br /> is <br /> /Z• / � �� <br /> 6d o <br /> u / / 4,L) <br /> •� ,r � r <br /> I-WLCS <br /> / fll / <br /> r Y Return by the 12th of each month to: <br /> Date Signature of Applicant Environmental Health Division <br /> 304 E. Weber St., 3nd Floor <br /> Stockton, Ca. 95202 <br />