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1-+ nt.t{[:Y <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT urn this form by thete <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Return <br /> of each month <br /> r; a�,�,��. phone: (209}468-3420 Fax: (209)464-0138 Web:WA W_Sj90v-Dig/ehd <br /> <I <br /> SEPTAGE CLEANER'$ REPORT <br /> Company Marne: pr�a f�l r5 b. <br /> Report for them h of: ^� yearaOl'� <br /> Company Address: r?O! t�ysCa,r IQ� o .o ��. 3 <br /> Sheet Address <br /> 3 Signature: l <br /> Ity G <br /> Zip Code r <br /> All information submitted must he corn IDtD, accurate, and le ibie <br /> UE OF <br /> DATE Al PROPS BUSINESS YOWNER ADDRESS WHERE WORK WAS DONE GALLONS <br /> PUMPED PROPERTY OWNER (R) RESIDENTIAL NAME OF TREATMENT <br /> PLEASE INCLUDE STREET @, DIRECTION, STREET t1ArdE ASID CI7y PUMPED f�-'? GREASETRAP FACILITY <br /> U �q 7l O / (C} CHET�VCRL <br /> co _ �. 3 Cit `y r• i '9• Yc <br /> w �i' s a,f L .. 3 <br /> c.� s <br /> <i <br /> ocily e . 17--1 � <br /> CL ►.At .., - �.�0?� 5 LQ"I r7ri'S _ Cit i��J' � <br /> ~ L lJa C <br /> o.IV � Q�Le� Ci 4 < < 3 Wim- !2 <br /> 4P. l� s City <br /> / Ch /do C <br /> i...'rO)r s9Gl�� z <br /> • <br /> Cit <br /> a <br /> t` L <br /> V Crt o <br /> m �- <br /> V - <br /> cV g <br /> L0 ,o <br /> m <br /> CD Cil o <br /> I <br /> LID <br /> Cif <br /> C'7 <br /> Cil 1 <br /> CD <br /> 04 a <br /> CD EHD 42-D4 — <br /> 1 7 12/[7!13 <br /> 5EPTAGECLEANERS REPORT a <br />