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m SAN JOAQUIN COUNTY <br /> E1dVIR0NMFI\1TAL HEALTH DEPARTMENT Return this Corm by <br /> m 304 East Weber Avenuc,3rd Floor, Stocktnli,CA 95202-2708 <br /> Ld TeLephone:(209)466-3420 Fax:(209)464-0138 Web: www.sjgov.org/chd (11e 12"i of each month <br /> m <br /> SE VrAGE CLEANER'S REPORT <br /> Compau)'Dame: C & C Portable Toilets, Inc. <br /> Report for the m th (IC <br /> Company Address: P.O. Box 1523 �' year <br /> Riverbank, CA 95367 Ziacoe. Signature: -Z-VI <br /> All informstlon subtnicted must be corn Iatc accurate,-nod le ibic <br /> DATE l;Abll.OF BUSIKES3 OR ADDRESS WHRRE WORK WAS DOTE GA1.10)<S (R) flyi1VufT1AL <br /> FVMPED PRopER*'1'O\VNVER ALLON CC) CKEASETRAr NAME OR TREAlIdEN'T <br /> _ ``.� TLEASE IKCLODC s7RrrT of, DIRECT,OK. STREt-r KArdCPUMPED <br /> O CITV (') ckrna�I FACILITY <br /> LLd00 z <br /> !Y i <br /> CD —i a City <br /> 07 <br /> citY <br /> 0 ` <br /> w Ll S'� <br /> 7 el <br /> city /nQ/�L <br /> o <br /> 50 c-2 <br /> -12 m / z <br /> ro m <br /> P city <br /> L m <br /> O t* m <br /> IL - <br /> © my <br /> as <br /> U Cti'n• o <br /> nl <br /> l7ry <br /> CiLy :5a] <br /> I n3 <br /> CJco <br /> a� <br /> m <br /> Ctly <br /> E11D z2-04 <br /> m 8/30/04 — <br /> .a <br /> V <br /> T N <br /> IA d <br /> L <br />