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c. RECEIVED SAN JOAQUIN ConNrr _ <br /> © 1'.NV1RnNML•1�rT'AL.Hr'ALTIi DEPARMLNT Return this form by <br /> ED JUN 10 2016 304 F-&st 1Veber AveAnic,3`'Floor,Stockton,Cil 95202-27OR (lie 12'x'of each month <br /> Telephone:(209)468-3420 Fax:(209)464-0136 Web:www.sjgov-org/chit <br /> N E=NVIRONMENTAL HEALTH SEP i ACE Ci.EANER'S REPORT <br /> PERMIT/SERVICES �1 <br /> Company •True: C $ C Portable Toilets, Inc. Report for the mfttlt af: <br /> P.O. Box 1523 / year <br /> Company Address: Riverbank, CA 95367 7,ac.ae Signature: <br /> All InrarmAltors submitted must be complete, accurLte ,Dd Ic ihjC <br /> DATE TAME OF HUSINIM OR ADDRPSS WHERE WORKWAS DOBE GALLONS (R) RWAIDENTUL <br /> (G) curwssziur MAIME OPTRSATME-a�T <br /> PUMPED PROPERTY OWNER rLCASE ItiCLUDL STRC¢T W. DIRECTION, STAEET NAME ATD CITY PUMPED C) 04MUCAc FACILITY <br /> 0 � <br /> .-r Q City <br /> N W � <br /> M I "0/ -:fa <br /> , <br /> M -+L— �� DAI-i C*- <br /> M z <br /> o zw � � <br /> W an <br /> (L O <br /> tr 47 <br /> MAO . y <br /> > <br /> Z <br /> W Gq Id <br /> 9 �b <br /> ZI- ,J Iz <br /> Ciry <br /> 0 _ <br /> Cih <br /> r- <br /> fiq CtIY t N <br /> r"r o <br /> co i z <br /> 14 <br /> L 'u [. ,c0 LDCDJ <br /> CD —d h <br /> 0 C14 _ l Cl+y <br /> U o <br /> QlV <br /> CD <br /> f <br /> 00 Ki+fliil•1 �C <br /> f/ V <br /> C � <br /> O <br />