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_ SAN JOAQUIN COUNTY L12"' <br /> rn this form by the <br /> �® / f each month <br /> \/ <br /> ENVIRONMENTAL i-{FACTSt DEPARTMENTt , 8205-6232 <br /> . ..[ECE1888 East Hazelton Avenue, s OMlehd <br /> ' JUN 14 2014 Telephone: <br /> (209)468-3420 Fax:(209)464-0135 Web:www, ygov. <br /> `, SEPTAGE CLEANER'S REPORT year Df <br /> Report for the month of: <br /> ENVIRONMENTALI <br /> Company WgVTISER C ( V �� Signature: <br /> Company Address: ID C1�y j coy zip coa® <br /> � <br /> strasi AddrWIa <br /> GALLONS (R) RE9®ENYI+><L NAME of TREATMENT <br /> (r') GREASETRAP FACILITY <br /> All information submlttad must he com late accurADDRESSWHERE WORK WAS DONE PUMPED C CHEWM <br /> E OF BUSINESS OR SlljVj8 <br /> DATE �+� � <br /> PUMPED PROPERTY OWNER PLEASE INCLUDE STREET A. DIRECTION, STREET NAME AND CIT <br /> CA z ®t Nnr <br /> 1} cr <br /> C <br /> C <br /> Cil <br /> c4 <br /> 0 <br /> 0 <br /> I cr, <br /> ..o <br /> � o <br /> z <br /> co Cl Q <br /> O7 0� <br /> OJ <br /> t Cll <br /> LD <br /> of CI <br /> m �- <br /> N Cil o <br /> 1 <br /> C,a,Fa <br /> Ut r- <br />.-1 <br /> Oil <br /> N <br /> Cl <br /> cv <br /> per-, SEPTAGE CLEANERS REPORT <br /> m <br /> DD n <br /> 9 <br /> EHD 42-04 a <br /> 1 ■ v■ <br />