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RECEIVED <br /> }' SAN JOAQUIN COUNTY <br /> FEB 0 9 2018 E <br /> CD „' ENVIRONMENTAL HEALTH DEPARTMENT <br /> s868 East Id azelton Averioe, Stockton, CA 95205-6232 Return this form by the <br /> LliENVIRONMENTALHE&TH telephone:(209)468-3420 Fwc;(209) 464-0136 VYeb:www.sjgov.orglehd f2ll of each month <br /> i �¢ Ra��`p <br /> PERMIT/SERVICES <br /> SEPTAGE CLEANED'$ REPORT <br /> Company Marne: <br /> s Report for them th of- year,�0� <br /> Company Address: <br /> Sfreet A <br /> Signature: I< <br /> CiLy,da`TZSS r <br /> Z�A Caste <br /> All information submitted must be Com fete accurate, and le ibre <br /> DATE NAME OF BUSINESS OR <br /> PUMPED PROPERTY OWNER ADDRESS WHERE WORK WAS DONE GALLONS fR) RESIDEWflAL <br /> PLEASE INCLUDE STREET a, DIRECTIDN, STREE7 NA«E ANO Cfly (G) GREASETRAp ;;T-Y <br /> EAT199ENT <br /> CJ PUMPED <br /> Ic} CHEM19CRL <br /> City rit/ <br /> co <br /> LU I dft V. te Tir C7-L <br /> ry <br /> S l 7 <br /> Q Gil <br /> s.. 00 CdY 1/o <br /> l��b p � ci ✓•a e� �.- <br /> Cit <br /> cit <br /> r� z <br /> N <br /> V Di IS► m <br /> CD <br /> v <br /> N Cit I <br /> Ln <br /> m <br /> C14 <br /> Cil <br /> cr <br /> _ 1 <br /> Cn <br /> co <br /> CiEy <br /> LO <br /> Co <br /> �- <br /> m <br /> N <br /> (T) Page of <br /> m EHb 42-04 <br /> (V 12)'27713 - <br /> m 5EPTAGE CLEANERS REPORT a <br />