Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVTRONKtLI,ITAL HEALTH DEPARTMENT Return this form by <br /> m 304 East Weber Avenuc,3rd Floor,Stockton,CA 95202-2708 (tic 12"of each month <br /> O <br /> w Telephanc:(209)465-3420 Fax.: (209)464-0138 Web:www.cjgov.org/chd <br /> SF&TAGE CLEANER'S REPORT <br /> Company Name: C & C Portable Toilets, Inc. Report forth me th 0E1 yeau;2 /c,-11, <br /> Company Address: P.O. Box 1523 <br /> Riverbank, CA 95367 �} Zip Cd. <br /> Signature; <br /> r <br /> All informalion submitted must be corn letc occuriLtc and legible <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK MIAS DONE GALLOXS (R) iRusw M1,U <br /> (G) cacwssTRAF OFTRHACME>17 <br /> pUfvTPED PROP$RTYdWNBIt ■LCAS£ INCLUDE STRE¢T 1!, VIRCCTION-. STREET MAPdL C17V PUMPI;U C rrKtut FACILMY <br /> z <br /> M w - <br /> 12 C:� (� �° aty 2 <br /> o <br /> LLJ <br /> N ZRdcin <br /> F•-I / C./ 3 city <br /> W y sem ' i2 <br /> �i <br /> city <br /> N o <br /> o <br /> City � <br /> L m-I - — _ o0 <br /> O m <br /> 0- LO <br /> U <br /> oa N -- - —... ... ._ qty .. <br /> U ck o <br /> - cel <br /> (TI Ory <br /> cD -4. <br /> O <br /> t` Chr <br /> (D <br /> N CAV — <br /> 00 <br /> I city o <br /> 8/30/04 <br /> n <br /> fu <br /> E <br />