Laserfiche WebLink
RECEIVED <br /> �OR4�.ca'cg SAN JOAQUIN COUNTY JUN 1 82o14 <br /> si ENVIRONMENTAL HEALTH DEPARTMENT ENVIRONMENTAvq this form by the <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 PERMIT/SE If each month <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> SEPTAGE CLEANER'S REPORT <br /> Company Name: �� Report for th -M-lpth of: year C�l <br /> Company Address: �� . j/-�i�'/!', �� L ✓� � � -�� Signature: <br /> / <br /> Street Address City Zip Code <br /> All information submitted must be complete, accurate, and legible <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS (R) RESIDENTIAL NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER PUMPED G) GREASETRAP FACILITY <br /> PLEASE INCLUDE STREET #, DIRECTION, STREET NAME AND CITY (C) CHEMICAL <br /> 2 i) cit A-1—#xC, <br /> y Yea eart;s Cit / isdD , ; if <br /> (� ,C1 ^/ Ti� /0,u city � � r L¢� //- <br /> &0671v' <br /> -f 6 - 77V040-0Ka*v Cit Gd b% t a <br /> C f nv Cit <br /> 70 1 E• � Cit <br /> City IL /I <br /> Awe Cit <br /> rA-vor 610 �� G, � cit <br /> %plli s iAvJ �` UD�r� L�JenOf E / City A <br /> 64,110 <br /> �� G oZ �'t) lril 'T e cit <br /> 64city <br /> r �. p..(.. ",11n 134 S r)t Cit <br /> at) 220 Al. D&% 6X Cit <br /> J,3 Or✓. / ✓I/. .sG�'f�ZIC1L cit / r f <br /> �91 �W2 GA,"'GA,"'d City P <br /> 123 Mi cit <br /> LITCit 5 <br /> Page of / <br /> EHD 42-04 <br /> SEPTAGE CLEANERS REPORT <br /> 12/27/13/13 <br />