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N <br /> Kt F.I <br /> SEP 12 2016 <br /> San loaciuin Pylic tieaftlt Services EWRONMENTAL HEALTH Report for the month of l <br /> PERMITISERVICES <br /> 0 Urwdrqnmer►ta) H h 5CM <br /> subm by <br /> a Po Box 2009(445 N.San Joaquin St.) Septic Tank and Cesspool -r- <br /> Stockton'Carkfw 6k 95209 Cleaners Report <br /> Fax:4640138 <br /> Ad[tress: <br /> Must be submitted by the 12 h of each month <br /> Date Mame of Property Owner Address where w#A was Performed type waste gat.pumped disposal site <br /> L t ` q i sQ <br /> rn azeCO DIP- 527 <br /> 2-C i }. Ban SAL <br /> c� - t <br /> 21 �qs c <br /> �/ c S2 r ct <br /> k� G� <br /> e� � S 1 u v <br /> 2Z,33 <br /> k T- <br /> a zo 9S ` G z <br /> S 72L �1 t man <br /> N The folk-)war a rpt from the code of Federal Regulations.Section 403'Report must be sig�rved by a corporate offker who can i TWN blvd the <br /> N <br /> Q <br /> Col [4RA c.� <br /> N <br /> i certify under pen&y of lam;that this document and all attachments were pre red urt er my diredion or supervision. <br /> o <br /> N F— <br /> rd - <br /> r-I � <br /> ^' U <br /> W <br /> N <br /> r <br /> Y <br />