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I ` <br /> -N <br /> a San Joaquin Public Health_Services_ Report for the month of �L�I <br /> Environmental Health Services <br /> PQ Box 2009 (445 N.San Joaquin St.) Septic Tank and Cesspool Submitted by:A44 _5e �10c, <br /> Stockton,California,95209 Cleaners Report <br /> Fax:4640138 Address:_la58 S, i !' WQtr, <br /> I' o Must be submitted by the 12`h of each month <br /> 0 <br /> .-Oa, <br /> ate Name of�Proper- Owner AddRbss where work was per€orr�ied " type waste gal: pumped' disposal site <br /> J-�- Yt nSv� Z 3 [r� a ttC - l� sr U S7Lvcr� <br /> 77 4 l �7 �5 Cl vv oe, Z/ it lclrr _17571 l l 1� 00 <br /> (.. (� �' /l (tIZ40Lao ft y. <br /> l� Tnne, 2- L2 C,_21_� (I U 'D r i <br /> .11 ro <br /> 7 2SS <br /> no <br /> _b e LC li6wo 6",57-3l� �� I Z4)U 1, <br /> �� 7 D V -- //)00 <br /> W <br /> It <br /> ° ��(J�j airr�lrr' r� c ��cl�� s� �r r �0 o 0 �� <br /> 7. l� a S 52i 1t ( <br /> /t fi <br /> Q � <br /> w <br /> Q 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 /> o company" <br /> I certify under penalty of law that this document and all attachments were prepared under my direction or supervision. <br /> CD <br /> CO <br /> CD _ <br />