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I <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENTReturn this form by the <br /> m 600 East Main Street, Stockton,CA 95242-3029 tZ�" of each month <br /> CL r ' Telephone:(209)468-3420 Fax:(209)464-0138 Web.www-sjgcv.orgfehd <br /> SEPTAGE CLEANER'S REPORT <br /> Company Name: P-0/75, Report for the month of: year <br /> Company Address: o.& 4i- L? Signature: <br /> Straer Address City Mp Code ` <br /> AH information submitted must be complete, accurate and ie Ible <br /> DATE NAME OF BUSINESS OR ADDRESS INHERE WORK WAS DONE GALLONS fR) R"5IENtuL NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER II PUMPED ('31 "EASE TRAP FACILITY <br /> PLEASE INCLUDE STREET •, OIR EC 7rON, STREET NAME kM6 CITY C CHEMICAL <br /> o�-1 s� .�• J�,r t5 Li�/�l 'Uzi J. r, e <br /> city <br /> 1 - S c� <br /> 1�D+1 ,c�/rJ.�yu C rr-ie—A !. �j�r'`cs` —� <br /> ! 0, /r f+'L1tra C •S TL•e:-IG-Tvt'7 �;.G, " <br /> Gvf„ <br /> fcmy -5!C C Ac_ ;rC.�r''' fi C C C" r� r <br /> �j �` ) �4 <br /> city <br /> cl t CCC I 5 C <br /> ` ftr: {''c: krcfah;rc� •3rI <br /> " <br /> City n •— <br /> �? ,*7-1C 5 3c star- <br /> -IQ l G jV, ; cdy Tc-c_;e-tt <br /> f '71 7 <br /> cl •Sec-/t~ T r --I •LCC' � i t. (" <br /> - <br /> f�f�lG` • Az: Cily r0��c'Feyi <br /> •tG•rD yr rn r >'z�n if�' Ic rc9 <br /> city <br /> 5l��X��i, ALL- lL,cff <br /> 6c.e.�ea-•:. ���r--� ['�'S I'Z c-t� ,�CA�•rt,.� cft cx T c r, '3 <br /> -� a?-i rf�D CIGc X3'7(� '�� �� �_ _ � •� lt�- � <br /> �-ilv !u dry: /n! ' lCcz cay5 E CC-may, C'4 C.L: <br /> 5_LC <br /> o EHO 42-D4 <br /> CA 1414107 SEPTAGE CLEANERS REPORT <br /> 0 <br /> 6 <br /> 0 <br /> N <br />