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600 East Main Street, Stockton, CA 95202-2708 the 12t1i of each month <br /> P Telephone:(209)468-3420 Fat:(209)464-0138 Web:www.sjgov.org/ehd <br /> �rPOR� <br /> t SEPTAGE CLE,ANER' RE PORT <br /> Company Name: <br /> Report or the tear V� <br /> Company Address: Signature. 1 <br /> Street Address i PCA <br /> City Zip Code <br /> All information submitted must be-complete, accurate, and legible <br /> DATE NAME Or BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS (R) RESIDENTIAL NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER PUMPED (G) GREASE TRAP FACILITY <br /> PLEASE INCLUDE STREE'r N, DIRECTION, STREET NAME AND CITY (Q CBEN11CAL <br /> � Ld ) City j �f <br /> s ~ Y Cit ►�— y"1 <br /> City i t— <br /> Al <br /> L i Cit <br /> Cittan <br /> / City <br /> City <br /> cit <br /> f Cit <br /> ) <br /> City <br /> Cit <br /> City <br /> City <br /> Cit <br /> City <br /> City <br /> Cil <br /> Cil <br /> City <br /> EHD,12-o4 <br /> Septic/Cesspool Report <br />