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►44111 <br /> SAN JOAQUIN COUNTY <br /> z ENVIRONMENTAL HEALTH DEPARTMENT Return this form by the <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 12th 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: ? fill �.�be# i �7 Report for th- th of�L&A-Z year �Z�7/ <br /> Company Address: /� �� �� ��.5, � irli/T�, �% (� Signature: e�� <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 tom— (C) CHEMICAL �^ ) <br /> r/•Z el r /' Cit 1/ /t/ ✓ <br /> �Sb // &t loot/ Cit Yt 71 <br /> J((/ / Ald arl City I <br /> �1Jvr✓ C�S �3�'S iO�dT rn,71`61cit &7—e <br /> h/ /e G/,67-2 jA ` G 1,V cit 1 /I 6;V 19AVe 4w".-<j <br /> %L Pv6� CJ Nc7 6 �Zct/ <br /> city // .S <br /> a D di 0 C�e () / City " o&Cs <br /> o�l cit <br /> a3 �-AJ-00 C&Aynt .8227 W.14411 Gds ll*VF city <br /> Q3 10. 1PI'y d IV;VCit ,/ 1 <br /> ��Z% ,�/sJ� i cit <br /> Cit <br /> a /- a iii/ S �i'/rgslC��Awe cit )( `:'OJ <br /> cit // -5a <br /> r L 1vg✓� cit / 1 _ Ox'acs- <br /> wvjm city 42 <br /> �u en fie✓ 3��c� 7 A611. city i1 / S?ld t 'l <br /> Page 7E of <br /> k <br /> EHD 42-04 SEPTAGE CLEANERS REPORT <br /> 12/27/13 <br />