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600 East Main Street, Stockton,CA 95202-2708 RECEIVED the 12t1'of each month <br /> W114 ,461E. JUL <br /> Telephone.(209)468-3420 Far:(209)464-0138 Web:www.sjgov.org/ehd <br /> 2 4 201 <br /> SEPTAGE CLEANER'S REPORT <br /> ACompany Name: Repot year Z <br /> Company Address: �� PERM <br /> ��1� Signature:_ <br /> Street Address City Zip Code <br /> All information submitted must be Com lete, accurate, and legible <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS (R) REstvrnTIAL NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER PUMPED (G) GREASE TRAP FACILITY <br /> PLEASE INCLUDE STREET It, DIRECTION, STREET NAME AND CITY (C) CHEMICAL <br /> citJZn ' <br /> 121 LY221cit r YJ DG <br /> City <br /> Cit 0 /�- <br /> I� <br /> ' Cil , �; p <br /> cit �1 t% <br /> 7 1 <br /> r k Cit <br /> w u' I city , Pals- (j- <br /> 73 <br /> A),'161Cit , S� C <br /> SDG qQ � <br /> cite <br /> / l 2 <br /> Lo <br /> l ^,l � Cil <br /> O 00 CA6 IBJ Cit J <br /> C� a l_ <br /> �� ��� 0 city C <br /> w � <br /> t <br /> City C <br /> Q9 t - <br /> i p Cit <br /> C city JLJLJ <br /> city C <br /> City <br /> EIiD 42-04 Seplic/Cesspool Report <br />