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RECEIVED <br /> m �n�"�'`r�c SAN JOAQUIN COUNTY <br /> m pa AUG 10 2016 ENVIRONMENTAL HEALTH DEPARTMENT return this form by fhe <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 n� <br /> Tere hone: 2 12 of each month <br /> i <br /> RONMENTAL HEALTH <br /> p t 00)468-3420 Fax: (209)464-0138 Web:wrww.sjg0v.orglehd <br /> PERMIT/SERVICES <br /> SEPTAOE CLEAiNEFi.$ REPORT <br /> Company Name: <br /> Report for the R10)7th of: <br /> �� � year <br /> Company Address: _ ?p/ /Pos7':5' � Signature_ .� <br /> Street AddiesS 3 <br /> Cary Zip CDde Y <br /> All information submitted must be complete. accurate and legible <br /> DATE NAME OF BUSINESS OR (R) RssloENnal <br /> PUMPED PROPERTY 01"B INEOWNER ADDRESS WHERE WORK WAS DOME GALLONS <br /> (G) GREASE TRAP NAME OF 7REATtNJ=N7' <br /> PLEASE INCLUDE STREET N, DIRECTION. STREET NAldE AND CITY PUiAPED FACILITY <br /> H /Z 9 `may•-C / � � / g (C) CF7ElA I,C�AL <br /> K// Cil �Y` P-3-f /� q, ��9 <br /> ljj ltv .4 <br /> cn <br /> .� JYs c✓'J/96 G L�i�1`� �o� cry � q c. fyvo /2 <br /> r d* c <br /> a _ vc, e- � <br /> Q �'� �7 ✓Y�Y /r ery S - city 710 �- �� Oe e <br /> c ey It o,,/mac S CAZ moo G• L e �' <br /> Cil <br /> c�I <br /> d- <br /> 0 <br /> Ci o <br /> z <br /> Ci€ <br /> N � <br /> � Cil <br /> m <br /> V m <br /> N city <br /> Ln .� <br /> m _ <br /> CD CiE o <br /> N _ <br /> I <br /> Cil <br /> 0 <br /> LD <br />� Clly an <br /> u� Q <br /> N <br /> iD <br /> m <br /> N <br /> M ago Dt <br />.--I EHO 42-04 _ <br />\ 12!27713 N <br /> 07 SEPTAGE GLEANERS REPORT u <br /> , N <br /> tl0 ■■■■■r■ <br />