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T SAN JOAOCINCOUNTY <br /> ENVIltONMENIAL HEAL'I'11 DL1'ARl'ML.%'1 Return this form by <br /> i. <br /> 304!vast Weber Avenue,,i'�floor,Stockton,CA 9520?-2708 the 12"i of each month <br /> Telephone;(209),169-3420 Fax:(209)464-01;8 Tfeh; wwkv.sjguv.ur'/elld <br /> SEPTAGE CLEANERS REPORT 4IFy ���,9.1 <br /> Q �} F-'• y Y. <br /> Company Name: G— r C. t C,- C Se tIt e'1 Civ— Hepor for tk a mu tl of: year <br /> Company Address: ` ! 4 1 `t� )60-?Ikl 6 de, 535V Signature: ! <br /> St%cl AS,L", City LF Coda <br /> All information submitted most he complete, accurate, and le Bible <br /> CREASE°D DATE NAME OFSL`SINESSOR ADDRESS WHERE.WORK WAS DONE CALLONS 4R) REASE rtA1 <br /> 0) (C:} CTnnr NAME OF TREATMENT <br /> L? PUMPED PROPERTY OWNEK PLEASE INCLUDE STREET M, DIRECTION, S"IRi':E"I' \A17a AND CITY PUMPED C CHEMICAL FACILITY <br /> co <br /> rFC <br /> f — City —– <br /> RE 9 Ov <br /> N <br /> (•ih <br /> C it.v 3 L0�O <br /> C11> ENVIRUNMOThEALTH <br /> CS,y. PERM T/SERVIGES <br /> f',r. <br /> ry <br /> C h <br /> Cin• <br /> Illy. <br /> City <br /> iry <br /> _...�._._ - .-...,_.. City. <br /> Cltr' <br /> co <br /> i City <br /> Q y� Cin <br /> COY <br /> — -- City <br /> C] <br /> CDCD <br /> r I } <br /> N <br /> O <br /> 0) <br /> Q 1'liil I''},'.-€iU: Sept a's paal Lepnn <br /> ,ti try?I�r;d <br />