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-?�Y�7 <br /> SAN JOAQUIN COUNTY <br /> r = ENVIRONMENTAL HEALTH DEPARTMENT Return this foram by the <br /> Ln 600 East Main Street,Stockton, Cil 95242-3029 I e of each arnanth <br /> a y TefeAhOne:(209)468-3420 Fax.(209)464-0138 Web:www.sjgov.orWehd <br /> SEPTAGE CLEANER'S REPORT <br /> Company Name: lL c-1-a Report for th th of: <br /> Company Address: 1j 2--2-8 Signature: <br /> Weel Address city Zip Code <br /> All information submitted must be completer accurate, and legible <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS (R) REm eNuAL NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER PLEASPUMPED {GI GREASE TFIAP FACILITY <br /> E INGLU DB STREET t, DIRECTION, STREET NAME AND CITY C cNFIlICAL <br /> _4 3 1 -'i�' :1I A L.,' �` <br /> .r i: t <br /> ['-" CRY 3 i C r_IK.1 <br /> ���� ► L'C_p p „ter l � l L'C.�iC.f C;1 1 S.CC <br /> _5 7C c-- <br /> -331 331 <br /> [a ti cii t Pei-. j'-' i <br /> m 1c�r C.ic 9U6 cv <br /> C2 <br /> a <br /> Sfl p i <br /> 4 <br /> O C <br /> /rN <br /> CAY <br /> car <br /> CRY <br /> cily <br /> Ln <br /> LP <br /> 01 <br /> O city <br /> cm a EHE 42.04 <br /> ? 1014IU7 SEPTAGE CLEANERS REPDRT <br /> a <br /> d <br /> Q <br /> N <br />