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.S. y OAI1 ALP►vuuq✓vvnA <br /> EZV lRONmENTTAL.HEALTH DEPARTNT-NIT Return this form by <br /> m <br /> 600 East Main Street,Stnckkfft,CA 95202-2708 the 12"of each moniU <br /> N mephone:(209)468-3420 Fax:(209)464-0138 Fyd vcww-sj90v.0r9'c!1 <br /> S <br /> S- ve -�pL Cin�+zALQ z SEPTAGE CLEANER'S REPORT' <br /> Company Name: <br /> D�� � V\L . Report for the mon-th o • YC2X <br /> Company Address: btignat�rs�e, <br /> � suffi nddnss City .p Crde <br /> Alt informRtian submitted must be com le1e, acc¢ratc, ao6 le ible (R) RESIDUNTU <br /> 1 GALLO (G) c1u�AssTle� 1�A7►fEORTHEATMLd�r <br /> DATE IMAM OF BUSINESS OR ADDROS WHEREoi4)RK WAS 4021E YU11fPEI1 FAC_IIlTL <br /> PUMPED PROPERTVOM ER PULASL LNCLURE STREET k, DIRECTION, STREET DAME AND CITY ( cuvwCAL <br /> CZT <br /> G5 ' <br /> S <br /> J <br /> Q <br /> Z <br /> Lcl 0 <br /> p Cu <br /> Y 0 6 2013 <br /> 041W <br /> 00 <br /> a <br /> r-, <br /> 0 <br /> z <br /> ao cit). <br /> m '� <br />� `� <br /> m C' <br />�D <br /> V G LY m <br /> m o <br /> CRYry <br /> cay <br /> a <br />� M <br /> i <br /> m Cay � <br /> o a <br /> I— <br /> m � <br /> a <br /> a <br /> Citya <br /> S�Sm"C��oo1^�rnt <br /> EIS 42 <br /> ■ 0 ■ ■ ■ <br />