Laserfiche WebLink
raul'r' SAN JOAQUIN COUNTY <br /> 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: ��� Pungaj-xi ° Report for the month of./6' vear HCl <br /> Company Address: 113 / ( Signature: �i(/G2�� <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 /> Lvov 6 7g liV/,zsd1/U/ N City S G iJ L <br /> a� 091e Zs 3a 0 6-UIOSZ- ln/ g 6 Cit f Y/��ODGG <br /> -Smfif q- 0 Dj <br /> / City <br /> Ll Cit <br /> ` Al& //ULU/VCit <br /> S toe f+ . <br /> S �v r /,SHu C i / , <br /> 5160 AldWERig n910 / vW, d(f/hu <br /> CTij /2 0,9V Cit <br /> F City ow1 l <br /> S yn• /7 L✓�SC✓/�uG7r .�o�� Cit <br /> c 3/a o AeVlgV Cit C <br /> 26W 4 City 5VJ I <br /> Cit <br /> S A5,-5 . dai17 86, City 3 f r 1 <br /> 6L� G�SruL %v� Cit 5Vd <br /> 39 MAIO ✓ / L1&1-,a r <br /> City I asp , , I , <br /> vbS2?2��, L Cit <br /> I,7sgo G1 se llz l led4c Cit <br /> Uf�'t 054tG moss ieVC), �'�q 3 y it! Ldwr./C �i X21 /�h✓,� Aq., /f/ld0, ,0 X, ;57 0 Page of 3 <br /> I, .I <br /> EHD 42-04 <br /> 12/27/13 <br /> SEPTAGE CLEANERS REPORT <br />