Laserfiche WebLink
. <br /> Septic Tank and Cesspool Cleaners Report (� g <br /> COMPANY NAME: l S <br /> 9 COMPANY ADDRESS: PD/ i1��1,0�3 <br /> REPORT FOR THE MONTH OF:_ ao!2 I <br /> i DATE NAME OF PROPERTY ADDRESS WHERE WORK GALLONS EIEANINGS W RE UNLOADED <br /> OWNER WAS COMPLETED PUMPED <br /> nano RECEIVD <br /> oar,�s a� 6� AUG 07 2012. <br /> 7 le tos fns/4S W 006 y c ENVIRONMENTAL H :LTH <br /> U) 7-1 c, <br /> 3 <br /> K �Y . <br /> d . <br /> o_ <br /> 0 <br /> z <br /> a <br /> r <br /> N <br /> V m_ <br /> Ln0 <br /> d <br /> N N <br /> a) <br /> In o_ <br /> 0 (V <br /> N <br />,D eo <br /> a <br /> eo <br /> m <br /> E <br /> Return by the l2°o!eaeh moeth to I CERTIFY UNDER PENALTY OF PE ~ <br /> m Environmental Health D"jo, G .'f T THE FORGODYG IS TRUE AND CORRECT. -� <br /> r 104 Kul Weber Avenue,34 Floor p_ /`1 — <br /> 0 Stockton. 95202 AT��-- y4 '— <br /> m <br /> SIGN OF APPLICANT � <br /> m SepRep Rev.12199 m <br /> W <br />