Laserfiche WebLink
htUt1Vr. <br /> Qr,,441!Y. <br /> JUL 13 2915 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT EWRONMENTALHEALTiReturn this form by the <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 PERMITISERVICES R t1' 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: ��� = 0, inJC Report for the-Month of: IJE year —� <br /> Company Address: <br /> 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 <br /> PUMPED PROPERTY OWNER GREASE TRAP NAME OF TREATMENT <br /> PLEASE INCLUDE STREET #, DIRECTION, STREET NAME AND CITY PUMPED C) CHEMICAL FACILITY <br /> cit 5DJ �BvaG i¢olvGl�sS <br /> 1V—Vu/ [.Sfr� g C/o l�vYGV /�Kl/� Cit / � <br /> al C/t 61i%/0(43- , / {�7;6— S- /� U City %/ <br /> 1�1//✓—ol�t1 r/fml lJ�VO / /61,W Cit �� 57)0 91 1 ( <br /> �o/r R City / 1��j�� �—� <br /> Cit ziedz ijz G1/ <br /> cit <br /> /'z'E4- <br /> Cit J I /Sod ) I I <br /> / o X53 3 Gv fZ G �%' ri�9vv� Cit I ,;?i� 7 , < <br /> �j .,,/�• Cit <br /> �C CJI/` % <br /> i nk Gl as /G'l/Jlsi/Z'j%= G Citv /SD O <br /> ✓ NrV a r s141 City a9<) <br /> Cit f/ OI/o I <br /> ►' /a Gt/r'�% ��� �v�� city JA <br /> / <br /> jo (JiYI a 1 7 - uS rr�i 7�' <br /> Cit it <br /> (o odv �t It <br /> Cit <br /> Page of > <br /> EHD 42-04 <br /> 12/27/13 SEPTAGE CLEANERS REPORT <br />