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%Mv051 S 04:01P Sun Valley Punping 2096676635 p.1 <br /> ■ <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Return this form by the <br /> Sun Vall7 1868 East HAzolton Avrnue,Stockton,CA 95205.8232 12tH of each month <br /> 9,819 S.TeKiter .Telephone:(2 09)468-.U20 Fax.(209)464-01S8 Web;www.5jgov.otglElhd <br /> Tavlkw�.(;A w%zw. SEPTAGE CLEANER'S REPORT �� .� 0C.J- ZOO- <br /> Company Name: Report for m nth of: year <br /> Company Address: Signature: <br /> .`,'vel nrlcnnc dly Zip Looa <br /> All Informallon nubmlltarl muni bw corn Iotw accurate anD 1a Iblc <br /> DATE NAME OF 9U81NE99 OR (R) �taDennn� <br /> PUMPED PROPERTY OWNER ADDRESS WIIEHE WORK wAS HONE 6A1.1.ON3 (o) OReAse yrrwr NAME 0I-TRCATNCN7 <br /> PLEASE IMCLUDe vrwrrT 1, niarrTln N, —.F— NANF INA G." PUMPED FACILITY <br /> CMtMIf N <br /> Clly <br /> M' <br /> 4{Iy <br /> Gt <br /> Ulty <br /> Ot <br /> Ca <br /> ru <br /> ul <br /> r.,y <br /> 2Z/F ul <br /> GI <br /> GI <br /> CII <br /> ENO 424Ot !}fV'7n4E.CLLANCRU 11001V <br /> 1Ca107 <br /> RECEIVE <br /> NOV U � 2078 <br /> ENVIRONMENTAL HEALTH <br /> Received T I m e N0 v. 5. 2018 3: O1PM No. 4361 PERMIT/SE'?t4CFs <br />