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RECEIVED <br /> J r SAN JOAQUIN COUNTY <br /> oReturn this form by the <br /> _ SEP 11 2014 ENVIRONMENTAL HEALTH DEPARTMLNT 12t of each monf[h <br /> V bin AK <br /> 6DD East Main Street, Stockton, CA 952D2-3029 <br /> ENVIRONMENTAL HEALTH <br /> To(ophone:(209)468-3420 Fax:(209)4fi4-Di 38 Web:wwws�gov.orgiehd <br /> PERMITISERVICES EPTAGE CLEAMER' REPORT <br /> c rPA- <br /> �•� Report for the nth of: year 2D <br /> Company Name: WE <br /> Company Address:-T*�f �J �{ UV-G, �` / Signature: <br /> r C,y Zip Code <br /> suact aea�c <br /> All information Snbmittsd must be coon Irate, accurate and le lble �R} NAME OF <br /> ADDRESS WHERE WORK WAS DONE QALLON8 {G} t�ItFwse TRN <br /> DATE NAME OF BUSIMM OR pUMPEp FACILITY <br /> PIJypEo PRDPERTYOWNER ►IEASL INCLUDE STREET f, DfRECTLO", STREET NAME AND^Cl7Y J� G Cf1EMICJLL <br /> W t nl C C V t �'l <br /> fi-SYIIy L�IYLT <br /> 511 er': t" GLIr`1 e- <br /> W I L4ctty <br /> W <br /> CAY <br /> m <br /> m <br /> LID <br /> r <br /> m <br /> N <br /> C <br /> --+ <br /> i4 ' <br /> m city <br /> CD <br /> NCAY <br /> OJ <br /> m <br /> N SEPTAGE CLEkNERS REPORT <br /> ETD 42-04 <br /> t 014JD7 <br />