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k� <br /> an Joa uin P blic i•feaft ervices <br /> N enal N Report for the month of <br /> CL s <br /> PO Box 2009S <br /> 445 N. an Joaquin St. <br /> 4 G 1 Septic Tank and Cesspool Submitted�y; <br /> Stockton, California,95209 Cleaners Report <br />' Fax:4640138 <br /> Must be submitted by the 12x'of each month Address:10 <br /> s <br /> 1 Q Date Name of Property Owner <br /> � P y Addre7here work was performed _ -type waste. .: <br /> _.W�, . ...�: . .. .. - __..._ gal:pumped.:. .,:. .. 'dispos8l siteCL <br /> Ilk <br /> �'je <br /> a� h� � <br /> V.1 VCLSG 6Ld1. i C' <br /> t <br /> '•S24'L t <br /> 231 <br /> cr <br /> w <br /> 0 <br /> 0 <br /> o <br /> z <br /> a <br /> 0 <br /> h <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 /> LO I certify under penalty of law that this document and all attachments were prepared under my direction or supervision. <br /> o ) <br /> 0 <br /> Q .1 <br /> 1 � <br />