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SAY JOAQUIN COUNTY <br /> m L';- RONMENITAL HEALTH DEPAR'tTfTT Return this form by <br /> d m 304 East Weber A.enuc,3'"Floor, Stockton,CA 95202-2708 the 12 of each month <br /> Telephone:(209)465-3420 F'ax:(209)4,64-013B We&www.sjgo-,•.org/ehd <br /> SEPTACE CLEANER'S REPORT <br /> Com anyName: C $ C Portable Toilets, Inc. Report for the memcb of.4 ycar';-� <br /> P.O. Box 1523 <br /> CompanyAddre": Riverbank, CA 95367 zip CaSignature: C�%1 a cr.��V <br /> o . <br /> A11 lnfarrnxtlon submitted must be complete, wteurPlc skDd le iblc <br /> (R) PBSIDFNI'IAi. <br /> DATE NA.MF OF BUSIKESS OR ADDRESS`VIBRE WORK WAS DONE GALLONS (G) GREASETRAr NAME OFTREAMENIF <br /> U <br /> PUMPED PROPERTY OWNER PUMPED FACILITY <br /> }LEAS£ IACLUDC STR[CT X, DIACCTIOK, S7REET KAIHL AND CITY CJ CRr1�RCAL <br /> CAS <br /> m <br /> 00 J 1 <br /> o a <br /> 0141 <br /> N Z <br /> Z <br /> O �'0 <br /> w �.h, / <br /> z lD <br /> W <br /> Ciry• __ � <br /> Ln <br /> CU <br /> D ! � <br /> 1 Cih <br /> 4) <br /> m <br /> L C sy <br /> L r7 <br /> City <br /> in v , <br /> U cri <br /> U m r <br /> 06 NT <br /> c1cti04 <br /> r <br /> M Citv — <br /> V <br /> City L <br /> 0 � <br /> It <br /> It C <br /> Ln <br /> i <br /> .�f <br /> o FAiD =12-114 <br /> V <br /> QJ <br /> v 8/30/04 <br /> to <br /> ca <br />