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N <br /> RECEIVED <br /> P <br /> MAR 0 4 2016 <br /> W 5"loaualn <br /> Public Health Services rt for tics month of _ r-Ua t.� 2 1�p <br /> Erwirotaental Heap r►�ir�►c ENVIRONMENTAL HEALTH <br /> F4 - PERMIPSERVICES <br /> a PO Box 2009(445 Al.San loatitdn St.) Septic Tank and Cesspool Submitted by. AC f <br /> Stockton,CaKornia,45209 Oleaners Report <br /> Fax 45401M -Add,ma10S83 <br /> Must be submitted by the 12"'of each month <br /> oDate Blame of Property Owner Address whm work was performed type waste gal pumped disposal site <br /> "' 2-Z &L6 go 00 <br /> -2 use Bu° G�Pr-t S L <br /> MR. 07 L 2 <br /> it u <br /> 0 2 <br /> .-t-- S. ( � <br /> v <br /> y Cud` 23 - a t u <br /> l` 124 C <br /> aALQ Ed FCq5231 L >> u <br /> 2- Mai 9'S t u <br /> q-5 f'e5(c(�i <br /> t� 4 <br /> I - q5U I (,L1 <br /> j I <br /> 73 . � <br /> Vic _c t Std Zt7on a <br /> :5E <br /> C'lVG{Ar t(2 Cir Z rt u o <br /> g52bS res 0knh&L <br /> Wei CosC--4 <br /> f'C' - f'?w else rer� <br /> N i <br /> U 5Za {1' r 77 <br /> N The fnllavviN excerpt from the code of Federal lt$gulatlom Section 403"RePOrt mast be signed by a Corporate officer wt)o can legally blvd the <br /> i certify under <br /> penalty of law that this dotartoerrt and all att-afimerrts were prePareoi under my Aretilon or supervision. <br /> N <br /> U <br /> d <br />