Laserfiche WebLink
°R4uttt' SAN aJOAQUIN COUNTY <br /> r 'ri ENVIRONMENTAL HEALTH DEPARTMENT Return this form by the <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 12th of each month <br /> ;• ;� Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> ` SEPTAGE CLEANER'S REPORT <br /> Company Name: SidatLv/" _ Report for t "mo th of: year <br /> Company Address://&U?�/ `� I <br /> I q6-)1030 Signature: <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 PLEASE PUMPED C') GREASE TRAP FACILITY <br /> INCLUDE STREET #, DIRECTION, STREET NAME AND CITY (C) CHEMICAL <br /> ` / /' !/lJ vn i% !`I✓� Cit <br /> Cit <br /> Cid, <br /> x1Ai 1'9*) z Cit <br /> Cit Iz5pdI I <br /> , o& " -< 2-V 75 k USI-A 1i o V%� Cit <br /> -Z3 6A' JYI FSI' ZI f/tidUAI !t/ 1�u�,� at <br /> C it <br /> WTI City 61je <br /> XeZ& " 7/9 �� 7 � Cit <br /> J/n o, Cit <br /> /— a W��/�if1L�Z'7Imi City V yl <br /> C . Cit IP tt [ <br /> 4 ' / Cit <br /> \ ^ �r /f� �• Cit / i r • r G <br /> City /I SUv64)C� <br /> City a <br /> Page of <br /> EHD 42-04 <br /> SEPTAGE CLEANERS REPORT <br /> 12!27!13/13 <br />