Laserfiche WebLink
Q�,qutN SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Return this form by the <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 12t" 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: Report for the I onth of: I66NA�/t year o�v/ <br /> Company Address: 3S��iEC ��, �fj� Jjj ¢. C;7S�' _ 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 /> !' 6-6 7d-,4i �c> �S 3 `y /��'�v'V �S%dC'�L/0 �Ov� G' Dv� // <br /> Cit <br /> f3vri 0/L �sl�i�/� Cit <br /> 2 3 U Gf/ ����� E city <br /> �N Cit I S20 <br /> Citl�Ui <br /> a city z4) ,C <br /> �v�r/ IEZs lrS�S Gr/�si� Cit <br /> Cit <br /> Cit S�v l <br /> '01 Jd A/d/L /f /s64) Cit <br /> �J Cit <br /> i Cit <br /> City .S7Jv <br /> Gt — /3 ✓vC2h9k.,0l r cit <br /> City <br /> cit t 3 u�c� l ► I <br /> � '� L55 5 Cit <br /> Page Of <br /> EHD 42-04 SEPTAGE CLEANERS REPORT <br /> 12/27/13 <br />