Laserfiche WebLink
Q�,441?i..c C E I VE E <br /> z � .o SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Ay 15 2017 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-623 `' ,. r Return this form by the <br /> Pi�$a�'�}P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.Sjgov,Qrg/�q ENTAL HEALTH i 2 of each month <br /> �1�5ERVICES <br /> //�� SEPTAGE CLEANER'S REPORT <br /> Company Name: � /1��1�1��, «jam ��?lh <br /> Report for th o th of: 21 6 year a U/' <br /> Company Address: Z�. .5 ia— a( _ <br /> Street Address �`� ') Signature: <br /> city Zip Code <br /> All information submitted must be com tete, accurate, and legible <br /> DATE NAME OF BUSINESS OR <br /> PUMPED PROPERTY OWNER ADDRESS WHERE WORK WAS DONE GALLONS PC) <br /> ) NnAL <br /> G <br /> EASETRAP NAME OF TREAI:MENT <br /> s� PLEASE INCLUDE STREET # DIRECTION, STREET NAME AND CITY PUMPED FACILITY <br /> �/ / �/✓ 'V C(�L�r'�j I Y _ �Uf�yL/ CHEMICAL <br /> /�1L.4�U r cit <br /> hlrws/ City <br /> Rtjl9-�-) cit <br /> IF <br /> yJ�� a <br /> City <br /> �i d1� C` / (r ��� /72y'd✓ (/9Gl/t cit i I <br /> 1/ <br /> /y <br /> ///C 0 /.�,5 �� S �o✓!V ICC cit <br /> aad o GV — , ., L � Dit � � sem• <br /> t � <br /> u' �� �G�S-l1/^ T hto,/ ov Cit 1 5 Gti r <br /> Lif <br /> cit / <br /> i271f7I i/ cit 5 dG' <br /> t t � <br /> v7o <br /> City ' sUd t L l I <br /> City <br /> cit <br /> �v J City <br /> 9(J lS .S i city i S�JU <br /> �oJ l) ).9n. y�,S' t <br /> at <br /> / �� ✓�• /i/ J�� Cit <br /> EHD 42-04 Page Df u <br /> 12/27/13 <br /> SEPTAGE CLEANERS REPORT <br />