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RECEIVE <br /> g4l.n SAN JOAQUIN COUNTY APR 17 2015 <br /> 5""1" A <br /> ENVIRONMENTAL HEALTH DEPARTMENT Return this form by the <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6 IR T/�L�if LTH 12t" of each month <br /> �`; a Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.stg <br /> ERVICES <br /> � SEPTAGE CLEANER'S REPORT <br /> Company Name: d����y iAUl(J R�/I//� j��Gf 0/-}, D&Sl'q(!Oi i CQ, Report for them nth of:i�iW14-1 year <br /> Company Address:// � j��rE,Q BC; � /G9/�1iA)z' Signature: _ !t/ <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) REASE TRAP' FACILI s i <br /> PLEASE INCLUDE STREET #, DIRECTION, STREET NAME AND CITY (Cl CHERiICAL <br /> /S -N_OU/9V j 2 a�/ 9�v' cit ��c'J �crJ� <br /> Js -N -/ ,0 FILV-1) 44fbVAI f-'-O+, City J1 L , <br /> A401 kkl/lel City <br /> Cit <br /> Cit <br /> �Fif / 7 D / Cit 1-0eE1W SDS ll l I <br /> ^1,23 'W' rj l JTL//�/yI� / Li4��c, cit <br /> Cit <br /> Cit <br /> a�33 G OV Cit <br /> l Cit <br /> C C 3()l J, 47r Cit <br /> City x.100 <br /> / Gild� GV !� i T/l�i/ /L /�(1'�D Cit 1 /-5-00 I t t I <br /> 41,1,0Cay <br /> Cit <br /> Page of <br /> EHD 42-04 <br /> 12/27/13 <br /> SEPTAGE CLEANERS REPORT <br />