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600 East Main Street, Stockton,CA 95202-2708 - - <br /> • Telephone.(209)468-3420 Fret:(209)464-0138 lfeb:tvww.sjgov.org/elid the 12tl'of each month <br /> SEPTAGE CLEANER'S IMPORT / <br /> Company Name: -` ` '� <br /> r`��l (.'Y - �� �` }' /• Report for;th month o . ye.�> : ; <br /> y' .--- <br /> CompanyAddress:� Signaturt•e:� <br /> � � <br /> Street Address City Zip Code <br /> All inrormation submitted must be coni let e, necurate, and legible <br /> DATE NAME Or BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS (R) RESIDENTIAL <br /> PUMPED PROPERTY OWNER NAME OF TREATMENT <br /> PLEASE INCLUDE S'T'REET 11, DIRECTION, STREET NAME AND CITY PUMPED (G) GREASETRAP FACILITY <br /> (C) COMICAL <br /> �ry '- - r � C�. �GF7 C �);-� � cit �° y`• <br /> city ' <br /> cit .—•+ <br /> /_/C <br /> CII <br /> '� �• 'fid -� � � �. / rt � �9 <br /> Cit <br /> Cil <br /> ,( i <br /> 11 t rt ej ("f �C ` , City r <br /> 'v �frr City <br /> t' i t 'h. Cit <br /> city " -!- <br /> 1 1 f. <br /> e AJ <br /> cit �J <br /> city <br /> C' <br /> City <br /> City • <br /> Cil <br /> Cit l <br /> l'ER �ER <br /> EHD,12.04 MIT iL EALT14 <br /> �1C._...__.. .. . <br /> Septic/Cesspool Report ES <br />