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i <br /> SAN JOAQUIN COUM'Y - <br /> m a HNVIRONmi[inAL HEALTH DEPARTUENT Return this form by <br /> Q� 304�Weber Avowc,3'"Floor,Stoc[cton,CA 95202-2708 fhe. 12d'of each month <br /> Telephonc:(209)469.3420 Fa (209)464-0138 rycb.www.cjgov.arg/ehd <br /> t <br /> SE,PTAGE CLEANER'S REPORT <br /> C 8 C �0[t3bl� TOi��tS} SRC. Report for the m (h of: C— )'eat—� <br /> Compatly ISarue; - <br /> p-O- Box 1523 Signature: <br /> Company Address: Riverbank, CA 95367 ` <br /> zr c e, <br /> All lafermg1[ou sa6mli(1td must be cam irre ateurafe, Rud Ie ibie <br /> {[i) PiSIflrM1.Li. <br /> DATE RAhTEOFBUsin OR ADDR SSNVURREWORKWASDONE Ga 11 OTS (G) rµeus�ur vARti30TTRUATMCN"r <br /> Y"Uj%jFF) PROPSt2T i,OWKEI[ ( <br /> YUMPFD FAC[LCTY <br /> ►LCAS� lIh CL�,OC SS;[L[T 1l, DIF LCY,o n, S7R[L7 HnitlC At;9 CITY C) C1tCMr(:4L — <br /> Cr <br /> IM I <br /> M j <br /> C - — <br /> J <br /> [tn - <br /> Ciy <br /> , <br /> r _. <br /> FL <br /> IJ k <br /> - -- -- <br /> U; 1-2- _---- <br /> C)n -- _ <br /> - <br /> IL <br /> c,zV <br /> — _ - — <br /> 0 C;i — �.. <br /> CD <br /> o _ _ _ <br /> (n; Ca) <br /> _ -- - <br /> C' E 11 42-04 <br /> to $!30104 <br />