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SAN JOAQ111N UoLjN"Cy <br /> v 1 T NI VIRONI< ' <br /> N _�{ n rAL J 1EALr�r Dcr a>cr&iLNT RECEIVED <br /> `�' / 640 Cast Main Street,Stockton.CA 95202-270$ Return tF�°rs form by <br /> CD I Telgho►tc:(209)468-3420 Ft►le:(209)464-0138 .w>tivc,_sjgov.orgJe the 12 'of each month <br /> F _ 'OAR 17'2015 <br /> _ W SEPTAGE CLEA NTERIS JAR <br /> Q Company Name: FORT <br /> Rap ! <br /> °�,q H <br /> Colnpany Address: ,ear <br /> Signature- <br /> Pip Cade <br /> All ln(ormelion tubmittcd a,ust be evm ICic accarste an,1 le Ible <br /> DATER <br /> i'ilA11'F,U PROPERTY o11'A6:R ADDRGS WHERE 11'ORK 11-AS DONE (R) RESIDENTIAL <br /> PI,CASE INCLUDE STREET a', ➢iRClY�pr StRELT NAMF 4241D CITY GALLONSPNAME OFTREjL-ntENT <br /> MrWCAL <br /> TJ✓<1FED (�� aRF�seTiyr racte,l'l'�' <br /> J <br /> w <br /> = GI <br /> z <br /> Id <br /> 0 - - <br /> 77 �M <br /> e 1 <br /> c• • <br /> Qty. <br /> c <br /> Lit o0 <br /> 0 <br /> 00 <br /> CD C M <br /> - - .— __ djy CSI <br /> to <br /> N — — Cil <br /> O <br /> _ CSI <br /> 04 <br /> City <br /> Ill <br /> m - <br /> m' cit E' <br /> QCA <br /> N lfl F— <br /> DLD <br /> FRD 4241 a <br /> r <br /> s�,ti�rc�s�l Rep�A <br />