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..T Ll L 2'SIf 56 2 W E D 1_1 747 : e/21 Ci P 0 Z. <br /> SERVICES <br /> AN �,.i)0IN C•uUncTY- l i <br /> a Rt i N San Jt;a qu j n st , P 0 . Box 20()3 <br /> • �t+Ckt4n, C:a 55201 <br /> r 205 i 46G-0310 <br /> KEt+WA$$E <br /> X8ALBI I5 <br /> Site Inform;(t.iont <br /> $ALB i 1i U*NG SARGHAUSEN ENGINEERS (BCE:f <br /> 151 L)Nk RSA :568 ARCH RD <br /> CORBEL I A CA a4SV5 .$TOCKTON CA <br /> ` C <br /> er,/ices were pj �;✓jcte-o for v,^tkj COY thrr Envirr..nmtentl tie&lthiv1 ion on <br /> a � <br /> JULY 2$, 199Z TOTAL OtlE t $37. 10 <br /> 110 days P"151 ; r ii, tf1+tsP <br /> F,Ea .E �tE'r4.rFrr <:.��tsF:': iti T kETORN PAYMENT ALCtNG WITH ONE COPY 'JV <br /> -PACE. PPvV I Ut, : '*1.14 WVH1h THIS STATEMENT TO: <br /> 5 aAYz, OF '!HS. ',A'€ t£ THISj <br /> NV-ITCF li +a1 11- 11" ATION i. Put-Hr Health erviteS, 54n 3oaquln <br /> t)' P.SC£IVEt.) till 'HIN THAT rt 1- County/Environmental Health <br /> :H r 1 Ui•Nz 3 l E Fci.z 2009, Stockton, Cd 9S.21'.11 <br /> 014E W I L!. 9E t. Gat.L Y RESP - <br /> It:LE Fsk IHI <br /> NOTE <br /> + THE APVVE 6(LL i Wo ADDRE' 15 #40T :0PRECT, PLEASE INDICATE BELOW: �J- <br /> ahE _-• .. . .. ..... . _. _... .. _.. __..__-__ <br /> PHONE #------_.,_-_- _ _ -- <br /> --- ---...------_------•-----------_»- __-•- ----- <br /> ----------------- <br /> r , _,TATE ZIP <br /> f <br /> I <br /> t d T 1 :t- 1 7-6/CO/8 t1od� <br />