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�. FNVIRONML\'TA]_ EIEAI.."IH Di'.PAK'1A41:N11' r Return this form by <br /> 304 Fast Weber Avenue,3d Floor, Siockton, CA 95202-2708 `� ' G 200 the 12'"of each month <br /> "\n, <br /> Telephone:(209)408-3 420 Fax:(2U())9(}4-0138 'Yeb:w%%--v.sjgov-orgich7'ENVIRONMENT HE <br /> �. <br /> SFP TAGS CLEANERS REPORT PERMIT/S' <br /> FRUfCEs <br /> Company Name: cl I <br /> Report for the month f' f� %t? year <br /> Company Address: `/ "I )w <br /> r )w / . . �7 � <br /> Saw:�ddcess City --- Zip code Signature: <br /> _ <br /> All inf»rnistion submiticd must be cum letc, accurate, and Ir ible F-WITP � <br /> U%TE NAME OIc IiUSj.NES5 OR AntlRESS WHERE V ORK WAS DONF, GALLONS (R) — <br /> MILD PROPFRI'1'OWNER (G) GAEASETFRer �.111Iii1.l '.j'FtF.AT1.7F.1\1' <br /> l'LF.ASF_ INCLUDE STREE4 to. DIi(ECT10N, S'IRFVT NAME AND Cir), PU IPED C) (10M1CAi. r.1A:ILl1'1'� <br /> City <br /> _ City <br /> ._. _ City <br /> - City <br /> _ city <br /> ray <br /> - cily <br /> City <br /> r b• <br /> City <br /> .. _ City <br /> lily <br /> Cath - <br /> C <br /> t'7 <br /> (int I i <br /> CD 7 .... - <br /> 04 Co., f . <br /> EPL)43,Q-Ili'i1 <br /> 1.-al]'Ilr14 S�pU c.Cy>spaol RPI+IaI <br />