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�Q�.i f, SAN,jOAQLIN COUNTY <br /> RECEIVED <br /> oin '�«�' aG 1�-_�u1 iE i.�i �i . i Thi DEQ-uRTNfEN' Return this form 4�y <br /> K-- East;:'c�?r..venue.3"F'acr. Stackaon.Com,95202-2748 the 12'x' of each month <br /> {� Tefepi�o�re: 40°' »5$ ^2C Frzc: 209) ;5= 4:38 Web: .,.tier.Si <br /> CHEMICAL TOILET CLEANERS REPORT NVIRONMENTA HEALTH <br /> i J G. Report s <br /> -Name: year <br /> Campan <br /> i r z .5 C rr <br /> pc '� 75 }`j Signatuire: n <br /> Company-Address: ` 3 Z, <br /> Czd- <br /> c, <br /> A;4 in:ormatioa submitted must tfe comr3fe[e. accurate, and le¢ible <br /> TOT.aLL's4B£R OF <br /> OTAL VOLL.SE OF N.atIE OF TREATMENT FACILITN" <br /> DATE CITY 1,VHERE PUMPED CH MICAL CITE'IICAL TOILETS CHEMICAL TOILET W.;STE WHERE CELE}IIC I TOILET WASTE I3t5kfJSEf] <br /> PUMPED TOILETS ARE LOCATED PUMPED Lti SPECIFIED PZ NiPED PER CITY PER DATE <br /> i t <br /> CITY PER DATE <br /> Ln <br /> T <br /> r / U — <br /> ,{ <br /> 1 / ii <br /> n Lw.,\ t <br /> E flt�i5� �oi +� <br /> o <br /> w f . <br /> } ft ACID � <br /> M <br /> E <br /> i.J <br /> B <br />