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tit(A ED <br /> MAR 13 2010 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT LNVIRONMENTALHEALT Re im this forint by the <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 PERMIT/SERVICES 12 th of each month <br /> Telephone:(209) 468-3420 Fax: (209)464-0138 Web:,www.sjgov.org/ehd <br /> n SEPTAGE CLEANER'S REPORT <br /> Company Name: f .���1)�2//1)cI 12.1 , SRG A' ,w.0i,JCi (,Q�- Report fort�ionffh, of: year <br /> Company Address://` J714(%�f'c2r1ut��LO, Signature: <br /> Street Address City Zip Code <br /> All information submitted must be complete, accurate, and legible <br /> DATE NAME OF BU5114ESS OR GALLONS (R RESIDENTIAL NAME OF TREATMENT <br /> ADDRESS WHERE WORK WAS DONE G CREASE TRA <br /> PUMPED PROPERTY OWNER PUMPED - FACILITY <br /> PLEASE INCLUDE STREET #, DIRECTION, STREET NAME AND CITY (C) CHEMICAL <br /> Cit <br /> a �✓1/ 1�49Z,d .SS' O� r city <br /> GV';rA)'0 wT G zl9uG Cit <br /> 8,0D 0 f—f C,J ete/'12,0 TS`, h city A 67 <br /> of t? ' 'A city /S o <br /> v0ds w i � cit 1l <br /> city <br /> 91. <br /> a �r� <br /> Al <br /> 4&CA1d1L f Gf�J ` /Il iv ci �D� u <br /> /D 5�1p d/ Z3/ i G(iG'9L �fi2� aLINcit 'I 3 Ove �c lI <br /> cit ESUd c <br /> WS /3/ City <br /> SJ <br /> ma�c U l �m a � &a 7 i cit <br /> (�'+) <br /> 0 '7 An% / %�/cJ� Cit 115 7) <br /> `67pl/—ou r6fi' 4�1 2Y7✓ /t t r <br /> '/ r f �/iT`/�61aUGI e city /( ��lJ <br /> �I 1 W dM-0,7 '4 W,SIr ()SkW/' � Cit / I' 6ldO ) f <br /> �cag-,I Z/BP/ s��t1i1, ;-9 Cit SI-60t,7-CA1 an <br /> Page�_of <br /> EHD 42-04 SEPTAGE CLEANERS REPORT <br /> 12/27/13 <br />