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CD ENTERED <br /> !oa uin Public Health Se ices <br /> �1LIljjro-_nmenta!_Heait San,;roc Report for the month of <br /> 1 <br /> I U Box 2009(445 N.San Joaquin St.) <br /> a itockton, California,95209 Septic lank and Cesspool Submitted b <br /> )�:4640138 <br /> Cleaners Report y <br /> �, t'ist be submitted by the 12th of each month Address:JJT <br /> 0 $ <br /> a <br /> Q Date Name of Property Owner <br /> _.Address.where work was performed - - _ - p <br /> w-. pe waste <br /> co �7-[D gai. umpedCF) disposal site <br /> � <br /> 00 <br /> E t i t <br /> � � �' �! 1 t rf <br /> —do FC �t52�l r� �, � <br /> Vt' tt It �Oc� <br /> JJ Z <br /> r r U f It Ii r rr rr <br /> ,� tr` � � — E l �t t��D ►i r r <br /> S ' { _'62 <br /> LU <br /> O ll Ef <br /> 0 <br /> 0 <br /> Z <br /> Q <br /> U <br /> H <br /> a <br /> w <br /> u7 <br /> The following excerpt from the code of Federal R ui <br /> company" ations.Section 4.03"Report must be signed by a corporate officer who can legally bind the <br /> C I certify under penalty of law that this document and all attachments were prepared under my direction or supervlslon. <br /> 0 <br /> 0 <br /> r <br /> LID <br />