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° • ° SAN JOAQUIN COUNTY <br /> c <br /> z ENVIRONMENTAL HEALTH DEPARTMENT Return this form by <br /> 600 East Main Street, Stockton,CA 95202-2708 ^C�\V/C D the 12th of each m <br /> T onth <br /> ephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.or V G C <br /> �P <br /> �IF00.0. <br /> SEPTA NER'S REPORT AR132Company Name: PaoN Report foAM� <br /> of:CompanyAddress: / � SignatuA H <br /> "et Address city Zip Code <br /> All information submitted must be complete, accurate, and legible I <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE GALLONS �) RESIDENTIAL NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER J PUMPED (G) GREASE TRAP FACILITY <br /> PLEASE IN CLDDE STREET M, DIRECTION, STREET NAME AND CITY Cl CHEMICAL <br /> cryJ S/ <br /> Z I� city SOD �. <br /> city ��Ile6ztic� <br /> ci 7si' <br /> City <br /> DD e-- <br /> cityZS'rJp ,C" S7' <br /> 'Ie- <br /> city pd <br /> , city <br /> c. S C> "'�2 <br /> City ✓ v G <br /> ✓!{j / ci Gry <br /> -vel 2�GI <br /> city <br /> Ciix <br /> -f� s - c, <br /> y City <br /> City <br /> EHD 42-04 <br /> Sepm;ACesgmol Report <br />