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6: a/C- 3 <br /> 5 16 TLI San Joaquin County'Environmental Health Division <br /> ENVIRARAM Septic Tank and Cesspool Cleaners Rep r4 <br /> Company's Name: SRC Pumping Co. <br /> f' <br /> Company's Address: 11350 Kiefer Blvd,Sacramento, Ca. 95830 <br /> Report for the Month O ; ) <br /> r <br /> Gallons Where Cleanings <br /> Date Name o Pro ert Owner Location Ct <br /> Pumbed Were Unloaded <br /> fGinl <br /> 022 <br /> /D <br /> 174 tff <br /> " Ci cG1 ol6`_ 2W� »1l 1 i <br /> U / <br /> L <br /> ;' — / AI-5-01V <br /> e1 E 4011 af),url ,4 , <br /> Return by the 11th of each month to: <br /> Date ' +gnatureofAPP lican t Environmental Health Division <br /> 304$. Weber St., 3,d Floor <br /> �� Stockton, Ca. 95.202 <br />