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ri 600 East Main Street, Stockton, CA 95202-2708 eaL�hlonh <br /> P Telephone:(209)468-3420 Ftct:(209)464-0138 Web:www.sjgov.org/ehd <br /> < FORS t- <br /> SEPTAGE EANER'S REPORT <br /> Company Name: i Ca�C n <br /> Report or the nth o <br /> Company Address: �- �S Signature: <br /> Street Address City Zip Code <br /> All information submitted must be Complete, accurate, anti legible <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS (R) nesIDENTIAL NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER PUMPED (G) RESjGREASE TRAP FACILITY <br /> PLEJA\S/E\INCLUUE STREET N, DIRECTION, STHEEIO' NAME <br /> ^AND CITY (C) CCRRENTICAl, <br /> \ uo �VV - �1 cit' CJI ( 1 0 f� r �• <br /> 11 City C-7 <br /> Boa <br /> \� \ Cit, C <br /> Cit � <br /> � ,/ ' <br /> W C1- <br /> \ l.�J - <br /> - !'�- Cit J 2 <br /> cit tv <br /> r 3l[p( Cit' �2 <br /> cc) i� a <br /> 1 Cil <br /> ` �G City o C <br /> N �x <br /> city <br /> / <br /> ,rte i t �� ;�s• <br /> ( I cit <br /> s- �� City � . <br /> 1 City <br /> }}/ city <br /> ILJ <br /> \ 1 C �" - t 1`��" City <br /> \ t) n cit f� <br /> cit <br /> 'L'e-)J city <br /> F!?,!2-04 <br /> ---• Septic/Cesspool Report <br />