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_ 600 East Main Street, Stockton,CA 95202-2708 the 12t"of each month <br /> Telephone:(209)468-3420 Fra-:(209)464-0138 Web:www.sjgov.org/ehd <br /> SEPTAGE CLEANER'S REPORT <br /> Company Name: '6-\o' <br /> ti Repo or onth year-� t <br /> Company Address: V <br /> Signa�rc. <br /> Street Address City Zip Code <br /> All information submitted must be complete, accurate, uDd legible <br /> DATE NAME Or BUSINESS OR (R) RPSIDENTI tL <br /> PUMPED PROPERTY OWNER ADDRESS WHERE, WORK 1VAS DONE GALLONS NAME OF TREATMENT <br /> _ PUMPED (G) CREASE TRAP FACILITY <br /> ,tom PLEASE INCLUDE S'rltEET ll, DIRECTION, STREET NAME AND CITY (C) CaENUCAL <br /> J y, �j 1 Q c"� tri <br /> L1 t�. CitWL6AA,j <br /> r �Cil ! / <br /> t <br /> cit -N :G <br /> e4 <br /> 0t ` Cit p1 `. <br /> f c Ci � <br /> V cit ( , <br /> ' cit fC)Cj <br /> cit <br /> y � <br /> cit ✓ I <br /> i a ( u9 <br /> City F— <br /> --- <br /> ' /tri /0--70 <br /> Cil <br /> i 0toi sial r <br /> 1 �t r l 6 <br /> t Cit <br /> city <br /> EHD 42.04 <br /> "'-"-' Septic/Cesspool Rcport <br />