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� apAKtit,� <br /> RECEIVED <br /> SAN,JOAQUIN COUNTY <br /> MAR 0 8 2010 <br /> ENVIRONMENTAL HEALTH DEPARTMENT Return this form by the <br /> 1868 East Hazeltort Avenue, Stockton, CA 95205-6232 <br /> (D ENPR�rALHEAL7klephone: (209) 468-3420 Fax: (209) 464-0138 Web:www-sjgov.org/ehd �2cn of each oath <br /> w �' 1r�1 <br /> Q65 <br /> SEPTATE CLEANE 'S REPORT <br /> Company nfaelne: pr a vs � <br /> ,yy�e Report for the nth of.- <br /> Company year/�al� <br /> Address: .?Ol /l_03Cb,r leo/ �'//o ,®� � ��r. �j`�s' Si <br /> Streetes <br /> Addrs gnature: <br /> Zip Cafe <br /> All information Submitted mUSt be eom lete, accurate, and ]e ible <br /> DATE NAME OF BUSINESS OR <br /> PUMPED PROPERTY OWNER ADDRESS WHERE VU(3RK WAS [}OtdE GALLONS �R) RESIDENTIAL <br /> A PLEASE INCLUDE STREET X. DIRECTION, STREET NAME AND CITY PUMPED (G) GREASETRAP t'rAt41E OF TREA7ri7EtU7 <br /> Z P(' /� / {C) CHMCAL FACILITY <br /> co 3Yt�- <br /> 0Q _71 <br /> � / �CCit <br /> /psi C. \ .0 0 <br /> > C,, Ci got ti <br /> n <br /> ret 44 dr <br /> ew w � //n4 <br /> 4 <br /> �•r Gi� •�.e, 600 .�.. ;{ rtlw•• e <br /> city4c '0 � . <br /> �s c. <br /> cily <br /> �l w � <br /> -/Oe-C .,�.� Cil ed� CXD <br /> m <br /> z <br /> cit <br /> r- <br /> N cr <br /> CD d <br /> V — <br /> N C�1 <br /> Ln <br /> oD <br /> m <br /> N Cil o <br /> I <br /> Ci w <br /> ('7 <br /> N C� <br /> Cil <br /> OD <br /> CSD <br /> Ci <br /> N a <br /> co Page of <br /> CD EH D 42-04 — <br /> C� 12127!73 u <br /> D <br /> 5EF7AGF CLEANERS REPORT a <br />