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San Joaquin Public ealth Services r� <br /> C" yjronmental Health grvirei Report for the month of <br /> CL <br /> PO Box 2009(445 N.San Joaquin St.) Septic Tank and Cesspool Submitted by: <br /> Stockton, California, 45249 Cleaners Report <br /> Fax:4640138 Address: C)58 <br /> Must be submitted by the 12"of each month <br /> 0 <br /> C3 Date Dame of Property Owner <br /> IM - p Y Address where work was performed type waste gal.pumped disposal site <br /> r LOG 0,TZo7 lrt��"t goo S~ C I�:iZvl <br /> N yl 7 EKa <br /> �1 L. C'S-2-35 - <br /> 53 W5_ C)ok_ l,.e e'i C S-tCkrt. ie# 12-0o <br /> [t V <br /> w <br /> H <br /> O <br /> O <br /> Of <br /> 0 <br /> Z <br /> Q <br /> U <br /> 0. <br /> W <br /> The following excerpt from the code of Federal Regulations,Section 403"Report must be signed by a corporate officer who can legally bind the <br /> company" <br /> I certify under penalty of law that this document and all attachments were prepared under my direction or supervision. <br /> LO <br /> o � , <br /> 0 <br /> a <br />