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t-hw,-0• w."Mt,d <br />rec <br />FAIRBAN KS ENVIONMENTAL CONSULTING <br />Mark R. Fairbanks, CUO <br />Certificate 46 5243795 -UC <br />Elly, Mirhe Dr%nA <br />Mountain Ranch, CA. 95246 <br />Cell # (209) 993-3298 <br />r k^-- 4 f')'ION '717/1_1 r -?r - <br />i Iivi 1...- �[�JJf ,J 1 1W -0V <br />E. -mail mrfairbanks@hotmail.com <br />I ICT C ---M+%, Cme�hvnn Tr- inion <br />v.01 1 U. -lul..r ulynvr�.�. I1�ulllly <br />Designated Operator: Mark Fairbanks <br />Date: 7/8/09 Facility: Food Mart Gasoline <br />Print Name 13ignature <br />1. Lit <br />2. <br />3 <br />5.ZI <br />7. <br />8. � 1'r-, f� ���� "a y a r <br />Zi A " � �H - <br />9. _ <br />10. <br />11. <br />12. <br />13. <br />14. <br />15. <br />16. <br />17. <br />