Laserfiche WebLink
a� <br /> SAN JOAQUIN CouNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Return this form by the <br /> 600 East Main Street, Stockton, CA 95202-3029 12a`of each rna nth <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org)ehd <br /> SEPTAGE CLEANER'S REPORT <br /> Company Name: CSG-hul-) F- Report for the month of: Platj year_2oiQ_ <br /> Company Address: 42213 N n N r Signature: <br /> 61rea Address Clry Zp Code <br /> All IaformatlDrl submilted must be corntete, accurate and lecilble <br /> DATE KAUE OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS � IR} REsoENTfAL NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER PUMPED I tG) GREASIS TKO FACILITY <br /> ?LEASE INCLUDE STREET S. MIRECT1ON, STRE2T NAME ANO CITY I10 CHSMMAL <br /> 12 fir{CK +heZO E 4.mcneA- L.n r 7k N 1 1200 Sum <br /> G-?m ]4 GOA 8$5^ S tFr French 1 12-00 swp <br /> CN <br /> 51114 -Clon 10 <br /> Lcorny.�i Rd <br /> co <br /> O n r o ; 5 Z 't f c f22'Cl citv moi!k--NJ F'36n <br /> CrN13GLf` t'�� 4 O �a GL.t'► kco Rd C Co-7 69J n <br /> 1� i-R12 s f c� -eSInCJ ckr CI-k-�! s !&Z- rGt1 n <br /> a 5fi2�) P0-C Y' C 4a ci, zoo �S r <br /> GCzrl��oU Hbb�i 1 aL4Aye c, :3TyjV 5 jFZ' <br /> ro fes ? to fo 2 a n Ca -R d cit, Sl-k- ! r' <br /> US (o5 Z15 Li nliemcLnn o 13q ro n 3382 2 <br /> t-rlesh `' r+ q2-C c G*-N 33 <br /> ` E v s z2S Y �-4r r1 a-MA/ 2 r <br /> Le 4o c STrk-�J �3 <br /> ?ME 1 I D I U)LA "' c. 3Q::) PN <br /> o <br /> 13 js v2 C,, —1 ),.<1\ ` 33 7- <br /> o <br /> o 2- r C_t-CL Zk511 a_U Tie-&I 335 <br /> C3 <br /> f�c.�-a drupe t �' �o 5 6<25 City <br /> Ci SI��j lA1i,' r3+may/ <br /> N Ci J lL-!V {r� f 6 1� <br /> r-I <br /> E H D 42-0+1 <br /> , 'WD7 -r41 V A SEPTAGE CLEANERS REPORT <br /> Z <br /> ��, '51 3 �� Br�.Ae r Car S•����• -Rd� Gr Gto <br />