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SAN JOAQUIN CQUNTY <br /> a=. ENVIRONMENTAL HEALTH DEPARTMENT Return thle.form by the <br /> ti <br /> 18658'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 CLEANEWS REPORT <br /> Company Name: 1C/ LOAz/ee �!tet i�lC Month of: y <br /> Report for the �,8 year <br /> Company Address: L1.3. r��'� �� � j, f� �� S Signature- <br /> Street Address City Zip Code <br /> All information submitted must-be comp—late, accurate and legible <br /> DATE NAME�OF BUSIN' OR ADDRESS WHEEZE WORK WAS DONE GALLONS IRI RESIDENTIAL NAME OF TREATMENT. <br /> PUMPED PROPERTY OWNER PUMPED � oREAsarw►P FACILITY <br /> PLEASE INCLUDE STREET # DIRECTION STREET NAME AND CITY CNENgCAL <br /> / hal city <br /> 1//Zrrr t2 66 u 7 cityr ' Ove <br /> a Cog y �/�- /C r�,� ,U9a✓� city, / / /,?3 <br /> mm cit so 0 <br /> cit <br /> a Pa� r <br /> 9�1SS S C0L -S• W111 J 14f c1 Sack <br /> St t v �C oZ L/7S—l/Uo'��/ T city JL f� -IJ2 00 <br /> St4A4V 9�i�-G/ 2�(7 b W -/0 49W/•T fl�' c, , UUP <br /> hI /DD"V,4—L D S Il 'zm—/-/-a 0 R0'9-V city <br /> 70 <br /> OA3 A) 1971F— city <br /> c/ Sti,✓ l�/�-G a�/`7,S �� /15'' ,� city <br /> fir✓ J 1 3 S`� oS' /�1297�oS'%icI' /' city <br /> nl✓3�✓Z�Rib li- SdGt /1�/U Is city / <br /> J5 �� %/v7W�3 /' J. <br /> �S��JUV <br /> cu <br /> 5 ilt/ G Biu 3 ju /± Ci% City <br /> Page of , <br /> EHO 42-04 <br /> 12/27/13 <br /> SEPTAGE CLEANERS REPORT <br />