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r-1 SAN JOAQUIN COUNTT <br /> FNVTRONME.I\'TALi1EALTIiDEPAELnfLTT Return this Corm by <br /> N m 304 East Weber Avenuc,3r4 Floor, Stockton,CA 95202-2708 the 12`''or each month . <br /> w TeMphonc:(209)468.3420 Fa,._(209)464-0138 Web:www.sjgoi•_org/chd <br /> Q- <br /> - SEPTAGE CLEANER'S REPORT <br /> Company Name: C & C Portable Toilets, Inc. Report for the a th of: year(�� <br /> Company AdP.O. Box 1523 <br /> Riverbank, CA 95367 zycoa. Signature: -Y1�A Cl- <br /> - <br /> l <br /> All lnformltflou submitted must be cam lett Ilecuratc and legible <br /> DATE 1`AAIS OF BUSIN'ES4 OR ADDRESS 1YHRRE WORK WAS DOTE: GALLONS (R) agclDrxrtAl <br /> N'T <br /> p (G) cltEAssTRAr KAXtEOFTR&ATME '• <br /> = rUtaRD PROPgRT1'4NVnR PLEASE INCLUDE STREET a DIRECTION, STREET RAM AND CITY PUMPED t'J cticl�cat FACTLTTY <br /> de,4, 033 2 � <br /> M _ , <br /> co J Cin. <br /> m a <br /> o z atr <br /> Z (J CiN <br /> h+ {� Ciry <br /> l <br /> w <br /> - — <br /> /- o <br /> toC N 1 <br /> ,.,.� City <br /> _ o <br /> ZIA <br /> City <br /> 00 <br /> L o 2 L <br /> EL COV r <br /> LD <br /> 0a m DDD o Ory - <br /> d- <br /> -12 I�CLQXA <br /> M02 <DC:> <br /> 2 �7� R -. City <br /> cit <br /> �tl.C� c>ly B'yL <br /> o m / — — <br /> LV - - Cityco <br /> F-- <br /> . � -- - - -- <br /> � <br /> 9 <br /> E11A 42414 – <br /> n 8/30/04 <br /> �o <br /> F <br />