Laserfiche WebLink
RECEIVcD . <br /> SAN JOAQUIN COUNTY <br /> L' � MARl ? nf <br /> L?V It� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 �ftp ENTgI H Ret r each form by the <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:wwW.sjgov.org/e�ic°T"IF�SERVjCE t', month <br /> S <br /> Company Name: <br /> SEPTAGE CLEANER'S REPORT <br /> ��, � C <br /> Company Address: /�j`�; Report fort nth of: �13 year <br /> r �� <br /> Street Address Signature: <br /> City <br /> _ <br /> All information submitted must be com lete Zip Code <br /> accurate, and legible v <br /> DATE NAME OF BUSINESS OR <br /> PUMPED PROPERTY OWNER ADDRESS WHERE WORK WAS DONE GALLONS (R) RESIDE TI L <br /> PLEASE INCLUDE STREET #, DIRECTION, STREET NAME AND CITY PUMPED GREASE TRAP NAME OF TREATMENT <br /> `- C CHEMICAL FACILITY <br /> .�OG/ City <br /> a z/ — IVO CA-fin Fn / to Cit / y�U <br /> City <br /> Clt � sc?v <br /> pit � <br /> cit' i <br /> �u�►ck/! fl/ivc �/ GfJ �l�rI/�ry G Cit <br /> S�L t 6,-S /6671 Z4 Cit <br /> ij X a2S�GU. />lE Cit <br /> /S Z-1h, /,5 3� W �C�����-ti �' ��lJ <br /> Cit i <br /> cit <br /> /'YIY� G L'L�j/L' / tS• /L�'j� � <br /> Cit l / <br /> two, G' uit/�. i� r; l� ScA,� / r Cit / � I <br /> JV JyJ iG✓o1'T/1F T Cit <br /> rrrelv,°,c Cit �I <br /> v � <br /> E <br /> Page i_of <br /> HD 42-04 <br /> 12/27/13 <br /> SEPTAGE CLEANERS REPORT <br />