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Fg)r; SM JOAQUIN COUNTY 0 -,e-- <br /> ENVIRONMENTAL HEALTH DEPARTMENT Return this formby the <br /> ENTEREE <br /> 101 MAR 0 2 2010 600 East Main Street,Stockton. CA 952021-3029 12e`of each mooth <br /> Telephone: (209)468-3420 Pax.(209)464-0138 Web:www,sjgov.org1ehd <br /> ENVIRONMENT HEALTH SEPTAGE CLEANER'S REPORT <br /> T <br /> Company NamURMI0 �%Mk, �4.> o <br /> Report for the M09th of., I-P year. /O <br /> Company Address: aa P n 4,,; 04 Signature- P4 46�' <br /> SVeel 4d*eas City Zip Code <br /> All Inforrnatlon Submitted mast be complete. accurate, and legible <br /> DATE NAME OF BUSINESS OR ADDRESS VUH ERE WORK WAS DONE GALLONS IR) RESIDENUM- NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER PUMPED JG) GREASE TRAP FACILrY <br /> PLEASE INCLUDE STREET It, DIRECTION, STREET NAME AND CITY IC) emmmAL <br /> C' Eerier Lie 8tee-e- cit, 5n, :33 P'.2, <br /> /L.,- City I e 4t,I L <br /> cft, <br /> p�t L.4-TprC to 33 S P'lz 1"Ae-c C'-' <br /> gly 1-,:.p 3-56 f'7 c�Yl Te 4C <br /> '7 /V z�-c%le'tc, C—A'47e atf (-6-7 <br /> &11ce 5 j" laC.. i.3 e-f /V City e ArjLI S e4l' <br /> C'!, r-r"c L <br /> a <br /> cify <br /> 7-C7 f. rt,-,7 -izw cily <br /> t -5 -2c Ci" 5-r4n <br /> I- <br /> 2-3-40 0 city <br /> sCtf M 14P 5-e 3-5- C4 city c-,4e <br /> 2-3- <br /> F- <br /> e' -t- CR-1 <br /> q F-1 c, 4-� <br /> ,2-L0 -6—i- 'i' 61A,,t. ,qef- cit, -57C e-- r <br /> city 5'ro <br /> ij <br /> -IC '7-It'L, " Ca mczzi4-e-6 &---' <br /> j a5n�5 <br /> o EHD 42-04 SEPTAGE CLEANERS REPORT <br /> 9 1014AD7 <br />