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EG <br /> Q�quln' ° SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT FEg 12 2014 Return this form by the <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-623212tH of each month <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.orgg/e <br /> EN%,e8gM ENTALHEpLT <br /> Q L / SEPTAGE CLEANER'S REPORT <br /> PERMITISERVICES <br /> Company Name: �� !� Azzza, 00_ Report for the onth of:,7,}au year _-2 <br /> Company Address: g-!5 � -` 8L � hX1 9� -: 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/71:1T STREET #, DIRECTION, STREET NAME AND CITY (C) CHEMICAL <br /> 3 z3alza,ia IriAlC - @ �f 95 cit <br /> '23U U City <br /> w ss sRD <br /> Cit <br /> / city /1 60 <br /> '�R _/W_S�d C s Cit <br /> Cit <br /> v 6_ r / Cit <br /> LGA I JC 12 9 SC)asr- cit <br /> Q/JTR 0%• /01 Al- X25/404/,57'_ Cit ( a ( l y <br /> / Cit �3 1600 1 ( l l <br /> �nnC ' 3 e✓ I C ity 16-04 / <br /> Z'9N� cit <br /> e L o2a� S- OMWIt�e Cit <br /> 'N- - u 8,�n� o2Ga5'Gt/�v7r !-9a✓� City <br /> cit <br /> City <br /> Page_J of <br /> EHD 42-04 SEPTAGE CLEANERS REPORT <br /> 12/27/13 <br />