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SAN JOAQUIN COUAT!'Y <br /> m h-NVIRONMENI'AL HEALTH DEPARnffirT '7- Return this form by <br /> N 344 East Weber Avenuc,3'4 Floor,Stockton,CA 95202-2708 the 1Zth of each month . <br /> m <br /> Q <br /> Telephone:(209)466.3420 Fat::(204)464-0138 I{'eb:svwtiv.sjgovArg/e <br /> hd <br /> w SEPTAGE CLEANER'S REPORT <br /> c� <br /> CL _ <br /> Report for the me�ntb of: AC_Company Aiame: C O BOX CP5t2t3ble Toilets, Inc. <br /> Signature.:l. <br /> Company Address: Riverbank, CA 95367 Zip C.a <br /> All Informilllon submitted must be cam niett. t+rcuratc and Ie iblc (R) RivuDCM7AL <br /> ADDRESS IVEIRRE WORK WAS DONE GALLONS (G) cRWCTRAP M1AhtE OrTRRATMEKT'- <br /> O DA'Z'E KAhtE OF BUSINESS OR PED FACILITY <br /> pUlrIPED PROPERTY O\VNRIt TLCAS£ IK rL0D6 STREET /f, DIRECTION. STREET NAM AND CITY MUM CTIEMIU[ <br /> N = <br /> co a <br /> a� <br /> u. 03 34Aw «y <br /> M bi at. <br /> W <br /> O Q Cih' <br /> O � <br /> N z D city <br /> 0 l �/ City <br /> H <br /> z '�' J <br /> city <br /> w <br /> 42 <br /> /2 T D C City `cam <br /> o City. .� <br /> 1 0 <br /> - 6w �O <br /> 2 <br /> L M `t'G� an fit/ Y� <br /> mD O Otyca <br /> U � DZCV o <br /> co :! ) j <br /> N /2 <br /> jO cily f _. <br /> CD - - •. Cil,• - <br /> .-i m City <br /> 9 <br /> CD <br /> r-1 aJ <br /> L,HD 12-04 <br /> n $130144 <br /> Io <br />