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600 East Main Street, Stockton,CA 95202-2708 L�ile— <br /> I <br /> 12`i'of each month <br /> ' Telephone:(209)468-3420 Fat:(209)464-0138 Web:www.sjgov.orglehd' t y SEPTAGCLEAN +R' REPORT <br /> Company Name: �1 y' �. rrJ 'yfC�° Repo port for th out of: year(22 <br /> Company Address: C ,-�,� '. ' Signature: <br /> G <br /> Strout Address City Zip Code <br /> All information submitted must be Com letc, accurate, and legible <br /> DATE NAME Or BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS (R) REs[DEnrtAL NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER PUMPED (G) (, LDE TRAr OF TREATMENT <br /> PLEASE INCLUDE STREET N, DIRECTION, 5TIIEEI' NAME AND CITY (C) CHEMICAL <br /> ` f -- City_ �. <br /> cit <br /> C 0 ,city ' <br /> f <br /> r ^` cit d ; -/• <br /> cit <br /> Cit <br /> 3 l � cit " <br /> i ) `► ' 7 % cit' <br /> U fic cit / <br /> City <br /> City <br /> G' L 0, Cit C ' <br /> y <br /> Cil <br /> Cily <br /> City t <br /> a ' <br /> 011311L� •` 7 / <br /> 1 <br /> city,, I C <br /> q Cil' <br /> Cit , <br /> CiIY I!Y <br /> EliD42.04 <br /> Seplic/Cesspool Report <br />