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SAN JOACIUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Return this fvrm by the <br /> s 600 East Main Street, Stockton, CA 95202-3029 12th of each month <br /> Tele home: 209 468-3420 Fax: 209 4640138 Web_www,s ou.0r iand <br /> A { ) t � J9 9 <br /> SEPTAGE CLEANER'S REPORT _ <br /> Company Name: S+Ocy--i-o i) f�' �-ro -R 'C -- -- Report for tit onth of: 3w'`1 year 2- l <br /> Company Address:.- 2-2" - o}{oRc , Aj Signature: <br /> Sirm Address City Zp Code <br /> All Information submitted must be complete. accurate and legible <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS CONE GALLONS (R) 9ES10EF TIftL NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER PUMPED (C') 6nEASE TRAP FACILITY <br /> PLEASE INCLUDE STREET E, DIRECTION, STREET NAME AND CITY C CHEMAL <br /> F+'xt 4 Less 2155 G marrh City 6 ------------- <br /> � <br /> L1. P' c ` l050 rOo 3?C1£ City 10Id46 ~ <br /> SL <br /> N i n fr 1 , j e r}") ftl� C3 J�J�i V' 112-00 t <br /> Co UICi f . C' 39 <br /> +2 <br /> l a ri co ,�,,JJ c. 5-f V,N FR <br /> 3� <br /> �-rermo-n }. �72 ' j E� + 0' Y k a Rd Ci G 33$Z R r <br /> fie ` 33 5 ,Y tr c; S`rw-kf I Z0 rJ S <br /> Ccunlvr 3' N I� Av u ?'kill 3 38 SuT <br /> fit'CL F W" n city NJ 5a <br /> -7 r <br /> ! L �d n r+ 3 I r 3 '+N 'Be 4"'ami r-1 - 1-6�a city 'i N 3 76Z <br /> r <br /> e�10 c f LLCr3 ' Z.r) Cify $ <br /> a k_ 1 ZOb <br /> Z en wa'T- 40 . "'a; Crud �- - aty <br /> '2'Zo 5 00T)z N 1 ! / 15(00 <br /> N G ,-d e re C c�K '-J 4 r '-fie? ;r t ; 500 <br /> Do EHD 42 4 _ <br /> 0 9A+4+U7 SEPTAGE CLEANERS REPORT <br /> a <br />