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.. °o SAN JOAQUIN COUNTY 11�� <br /> r. z` ENVIRONMENTAL HEALTH DEPARTMENT R ���1 / (iieturn this form by <br /> ` 600 East Main Street, Stockton,CA 95202-2708 �J cre 12m of each month <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd yy qq 1 <br /> o �tPoa s OCT 1 G 2011 <br /> SEPT G ANER'S PO T rtt�Company Name: Report foyear c�_ <br /> Company Address: 1 Signature: <br /> I dress City Zip Ca e <br /> All information submitted mus[ be complete. accurate, and legible <br /> DATE NAME OF BUSINESS OR I ADDRESS WHERE WORK WAS DONE GALLONS (R) REsmeNTUL NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER PUMPED (G) GREASE TRAP FACILITY <br /> PLEASE INCLUDE STREET p, DIRECTION, STREET NAME AND CITY (C) CHEMLICAL <br /> City t CSD fi <br /> Ci <br /> �� / !� • v h <br /> ":'0' DO ' city /S/ 42n/) <br /> cR <br /> r rtA6rTlPtl / ) <br /> �17 // r City - <br /> � v � <br /> .a � . ,�;� ,. ' -�" ' �� ✓ ^ sod R. <br /> Ci <br /> . <br /> f <br /> Cil <br /> f <br /> city O r- C <br /> ci <br /> " r <br /> City <br /> / D Ci <br /> civ <br /> City <br /> ciy <br /> s Cit <br /> ERR 42-04 <br /> Septic/Cesspool Repos <br />