Laserfiche WebLink
�r,,441>Yo <br /> •ar.�-.a <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ' 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Return this form by the <br /> a `� Telephone: (209) 468-3420 Fax: (209)464-0138 Web:Www.sjgov.org/ehd 12t" of each month <br /> Company Name: <br /> SEPTAGE CLEANER'S REPORT <br /> � ) ��� � , � � • <br /> Company Address: « Report for the month of-�3 '� _ �lG year b�0/ <br /> Street Address J Signature: <br /> City Zip Code <br /> All information submitted must be complete, accurate, and legible <br /> DATE NAME OF BUSINESS OR <br /> PUMPED PROPERTY OWNER ADDRESS WHERE WORK WAS DONE GALLONS �RZ_RE$IQCNTIAL <br /> PLEASE INCLUDE STREET # DIRECTION, STREET NAME AND CITY PUMPED G) GREASEI NAME OF FACILITY CILITY`MENT <br /> =V / <br /> SAu 54 CHEMICAL <br /> r�/ cit ALL �J��S <br /> a 3 V Zvbvh Ai72 o R city ; <br /> f S S cit IJ (\ <br /> V Cit I \l <br /> c L Jy90 j <br /> Cit' <br /> City <br /> r— <br /> p Cit <br /> p f <br /> <7.17 L ..F�b <br /> ;e City <br /> 17z Citv <br /> S GC✓'ri 1 / �� ' p r 7 cit 7 7 <br /> C <br /> it r 1 <br /> cit <br /> v City 5�f, <br /> cit • �� lit/�� <br /> cit Il �v <br /> EHD 42-D4 <br /> Page,' of . <br /> 12/27/13 <br /> SEPTAGE CLEANERS REPORT <br />