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,4 S.4N JOAQUIN Cot_wrl' <br /> 8NWROTlMENTAL HEALTH DEPAMIENT Return this Corm by <br /> m 304 East Weber Avenve,3r1 P100r, Stocktcn,CA 95202-2708 the 12''of each month <br /> P7 Telephone:(209)468.3420 Far=(209)464-0138 Web:avww.sjgar.argh:htl <br /> a SEPTACIE CLEANER'S REPORT <br /> a -- tt of: <br /> Company Tame: C 8a C Portable Toilets, Inc. Rclif;rt for the arent <br /> Company Address: P.0. Sox 1523 <br /> Riverbank, CA 95367 signature: •,. �, t�.ha .- � Lz}1 _�. <br /> �a <br /> All ltfforrnxtion submitted must ht curn lett Fccurafe, and le iblc <br /> (121 R1LS1"LN 1 L4L <br /> DATE KAME OR BUSWESS OR ADDRT,SS IY47 M.wORKMIAS DONE GALLONS (C) CAVASETW KAlME OFTRiRATMi£NT <br /> CT PUMPED PROPERT]'OWNER IFLrASE 1t:CI.01PE ssnr{era, DIRECTIO�N,'STRCf.7 "AMA, Ast, C11r rumffD Pr"rMIC_AL VACtLM <br /> N a a �1 Ju <br /> C �T 211 � /I } <br /> — _ Cit. JC.(/l� l l <br /> city <br /> Q LL) <br /> - <br /> 4, <br /> i (—L) cin <br /> � 1 A <br /> -i1 ! �+_1 JZ ! '� `�, LA '-1 <br /> P A-Qin— ,.a/ a f1 - 1( 4 } 1Ciry <br /> � � !` - —,± l., r' r�_ _Lam_!�Ji ,.k. C1Y•- 1�+�_-- 'r"M <br /> civ <br /> L <br /> Lz <br /> on <br /> CL <br /> t..l <br /> Oa <br /> U <br /> n,} <br /> Ory <br /> O <br /> C1sv _ —. .- <br /> O <br /> VN} V L17 4244 <br /> 8130104 <br /> U , <br /> a <br /> A <br />