Laserfiche WebLink
RECEIVED <br /> Q�auln' MAY 14 2014 SAN JOAQUIN COUNTY <br /> , - ca <br /> r.. ENVIRONMENTAL HEALTH DEPARTMENT Return this form by the <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 12th of each month <br /> n p� ENVIRONMENTALHEALWe/ephone: (209)468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> PERMIT/SERVICES <br /> SEPTAGE CLEANER'S REPORT <br /> Company Name: ne)- �}� / Report forth on h of: year a� <br /> Company Address: //3 / �C ( 36 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 PUMPED G) GREASETRAP) FACILITY <br /> PLEASE INCLUDE STREET #, DIRECTION, STREET NAME AND CITY (C) CHEMICAL <br /> A/ S �lG v.J QD e,T�}" ftIz/xlb A0 D at <br /> /N9011/'ATf>• u/ cit <br /> %e0 ,Oi4l- C /d1780 uJ g City zveh('wD /'l-oo t ( /I <br /> city <br /> ewtj'�A Awe)/ (.W/ . fC 7C MT fit/ ZA 9h),-�c Cit <br /> Oyu/1/( iW -'Y1/-z. Me ��r Cit <br /> &i/l/ 4 iv�rcl+9G%� s)- AuCity <br /> )-rV-Our aw a6aS W�ft6ir����v E Cit <br /> Lei / 30 1-64411 !kIM 944D cit <br /> (0 - U jo Cit SSOo t i <br /> 0�0� �I -1 (/U �l.Er"),*U ZAV2 cit I I r t l <br /> C A/ 6OS J �GvD' /7vly/1/�L City it I <br /> City lad <br /> `� 1✓v"lJ , I�� /y�� � �; />Gcity <br /> ALJ G✓ / / �d m�✓/u 45�� / Cit <br /> A&�;A) Cit <br /> Page / of <br /> EHD 42-04 SEPTAGE CLEANERS REPORT <br /> 12/27/13 <br />