Laserfiche WebLink
RECEIVED <br /> MAR d 6 2018 SAM JOAQUIN COUNTY <br /> E'JVIRONMENTAL HEALTH OPP RTMENT Return this form <br /> by the <br /> ENVIRONMENTAL HEALTH, 1868 East Hazelton Avenue, Stockton, CA 95205-6232 12th of each mouth <br /> 4 <br /> 209 <br /> efephone: ( ) 68-3420 Fax: (209) 464-0136 Web:www.s ov.or <br /> PERMITISERVICES J9 Jehd g <br /> 1 i n SEPTAGE CLEANER'S REPORT <br /> Company Name: IC{ <br /> Reportfor the month o : y <br /> Zip ear 0 I, <br /> Company Address; -� f` r;�-� ` j ��'riCG C- '�;Q - <br /> Signature: <br /> �n SirettAddrass J C3� <br /> All information submitted must be com lele, accurate, and le Ibfe r_ <br /> DATE NAlv1EOF BUSINESS OR ADDRESS VVH ERE WORK WAS DONE GALLONS �R� kc51JEJTIAt NAME OF TREATMENT <br /> rn PUMPED PROPERTYOWNER PUMPED {G} oREaseTluP FACILITY <br /> O PLEASE INCLUDE STREET C, 61F.ECTION, STREET NAME AND CITY C CEEN,�pt <br /> N <br /> C• <br /> LP <br /> 1n <br /> C& <br /> m <br /> cry o <br /> cit <br /> Q <br /> M <br /> C <br /> n - _.. CC> <br /> ID o <br /> of <br /> - I <br /> i <br /> C, <br /> r' <br /> G' <br /> ti <br /> N City <br /> N , <br /> m Page of _ <br /> G <br /> >1 z <br /> ■`b ■ ■'*n 42-04 <br /> ■%EM%Wi13 SEF TAGSUFAN'EIRS REPORT <br />