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tr <br /> O♦ ^Rrv��r., SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Return this form by the <br /> _`` 600 fast Main Street,Stockton,CR 95202-3029 12 ' of each month <br /> Telephone:(209)488-3420 Fax:(209)464-0138 Web:www.sjgov.org+ehd <br /> SEPTAGE CLEANER'S REPORT <br /> r <br /> Company Name: G +,C '}t'3D !� Repor##or 1fie month of: 'r - year 2-15 i0 <br /> Company Address: Z 1 -UjrQn Rd :3f kL j 7-00 Signature: <br /> Strad Address Chy ZiP Ccde <br /> All Information submitted must be complete, accerat®, and le idle <br /> HATE NAME OF BUST HESS OR ADDRESS WHERE WORK WAS DONE GALLONS IRI RESIDENTIAL NAME OF TREATMEUr <br /> PUMPED PROPERTY OWNERi PUMPEt] (0) (MBEASE TRAP FACILITY <br /> PLEASE INCLUDE STREET L, DIRECTION, STREET NAME AHD CITY C CHEMIC/LL <br /> I <br /> 13(4-1 5 r-r D I ada `24 <br /> r(,IP-L -IZl r.,If)t-)n rt ciw *-N 1000 , <br /> CD ° LP G j 140" , r+ c i oo f <br /> co <br /> 20 F-ms Cl ZO.Lbaw 7Rc S'—.LN 3352 <br /> �o0 4 Les 5 Z55 E karch 1900 G J '` <br /> -7`21 i <br /> `fir 2i1S VY Eashm n 1 TKN i000 , h <br /> r o <br /> Ila G6q�2 N- 2!rsh-r&q Ave i2.ob <br /> S-aScu-a Lee 2.651 S j <br /> Alr;22r+ r c kN 2- <br /> n o. u,-,n <br /> r <br /> )L10q S Fnesqo)L10 Ave c ,-rI4N 13332 f' <br /> ctrl Y f S� ,moi citySTkN ZL4 Lia <br /> 0 22 ci <br /> r ' <br /> hi ? t ;� G <br /> o tiJ^^, �•- r n e r Ci <br /> C�l <br /> city <br /> —I EHD 42-04 SEPTAGE CI EAKIEERS REPORT <br /> Y <br /> 0 101N07 <br />