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r%j <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Return this form by the <br /> 600 East Wn Street, Stockton, CA 95202-3029 12'4 of each month <br /> Telephone:(209)468-3420 Fax. (209)464-0138 Web:www.Sjgov.org)ehd <br /> SEPTAGE CLEANER'S REPORT <br /> Company Name; Roto cx^ 2r wrl IDRK Report for then)onth of: P1 Pfe I year 2-0 i r) <br /> �4r <br /> Company Address:. 4ZaS Np_tu -o� r% Jad iiA !�rlk-`KJ ri 52055 Signature: t t lov" <br /> SlseetAd*ew coy Zip Coale <br /> All Information submitted must be.complete, 8ccurate, and legiblo <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WO RK WAS DOME GALLON, (R) RFSECIEIKTGIL <br /> NAME OF TREATMENT <br /> PUMPED = PROPERTY OWNER PLEASE INCLUDE STREET 9, DIRECTION, STREET NAME AND CITY PUMPED (G) GREUETPAP FACILITY <br /> (C) CHEMICAL <br /> G C- Sri e _[tt cyrK t,4 <br /> q-01 TA- <br /> ('0 RC( c,v G -A/ R Sir' <br /> cj�' 5-rkN izolo <br /> cr) ta4 1)pEg-do �s <br /> M rl,- 52- NeSt L-n cl r I K" <br /> f Irj.roX ?fm,P 6005 RrC, ]RIO <br /> DO <br /> H ' !3 D11202- W021�Ij 562-0 Lj Ak,v Pc. S T�NJ i L400 <br /> vjapo-- : 3Lf-3c-,- d" cqr S TKK <br /> e 14t? ( 6 cfty K rq r-- <br /> �tjI±5L <br /> t5 Lee-chp vtalb; e-1 3 LiSs P-1 C-i city 's-r-KN & T&Lj <br /> baaDtl Rio Hr� <br /> '1'-f 25 A Pc,r+ �jcg my !S-rK N ) -350 <br /> A--IESS 3Lt 34 4 C1 CiLy S--r'K N <br /> veicit, G f ;'-'N 600 <br /> C", S VLN 's,�v <br /> �3 0 R�o Ro <br /> + <br /> �vq <br /> ?ch&r-H Pe w.L-r-� C*v GT KN J200 <br /> ?6enA -Ri,:3 -&w-wo ?,d cj, !S� T f'- TR <br /> P-d Car <br /> 3gai3z <br /> -j Ave C;�y G-rk-N .31 <br /> CD n J'E Rrf C4 Fre.nch ( - T W <br /> I 0 <br /> CD <br /> EHL)4z-o4 <br /> N p�O- R�t;4v L2 SEFITAGE CLEANERS RrED RT <br /> C' <br /> q <br />