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San Joaquin County Environmental Health Division <br /> Septic Tank and Cesspool Cleaners Report <br /> Company's Name: SRCPuinping Co. <br /> Company's Address: 11350 Kiefer Blvd, Sacramento, Ca. 95830 <br /> Report for the Montt <br /> Date Name ofPronerty Owner Gallops Where Cleanings <br /> t � Cit <br /> _I� � � Location --y Pumped Were Unloaded <br /> TN' IL I/ <br /> i <br /> B <br /> 1 30? W <br /> � >I 5vo <br /> IZil! /� <br /> 1)� Z ,A2 V� <br /> I ,-O /l <br /> 57J S.f��✓ � i/ 6 1� i � <br /> Return by the 12th of each month to: <br /> Date Signature of Applicant Environmental Health Division <br /> 3046. lVeberSt., 3rd Floor <br /> Stockton, Co. 95202 <br />