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T <br /> San Joaquin County Environmental Health Division <br /> Septic an and Cesspool Cleaners Report <br /> Company's Name: SRC Primping Co. <br /> Company's Address: .11350 Kiefer Blvd, Sacramento, Ca.' 95830 <br /> Report for the Month Of.• / 1? <br /> Gallons Where Cleanings <br /> Date Name a Pra er Owner <br /> Location Ci ' Pumped Were Unloaded <br /> r <br /> fF 07;Z -&)4y- / <br /> ! 0J, it T% "I/ <br /> i <br /> Zr �N1 L � <br /> e�nvd tie�179 G(�s i oS12-34 <br /> �ynr <br /> r <br /> �o Psi! <br /> A <br /> -- Return by the 12th of each month to; <br /> Date Signature of Applicant Environmental Health Division <br /> 1304H. Weber St., 3rd Floor <br /> Stockton, Ca. 95202 <br />