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05/79/2009 09:09 FAX 2098239095 IM 002/003 <br /> Sfnnl r <br /> DEPARTMENT OF ENVIRONMENTAL RESOURCES � <br /> 3800 CO MCopia Way, Suite C, Modesto, CA 95358-94 ? , <br /> Phone: 209.525,6700 Eax: 209.525.677 <br /> i;nly <br /> i SEPTIC TANK PUMPER DISPOSAL REPORT <br /> 4. <br /> r,DR THE MONTH/FEAR OF Al 0 <br /> DISPOSAL S TE (Phase Show Address): <br /> 4 <br /> F <br /> BUSINESS NAME_ MONTHLY TOT ALS_ 7b ' �alloi�s . <br /> ;DDRESS - I D NUMBER i <br /> TANK CAPACITY ? _ <br /> 4 <br />+ I. <br /> I � <br /> Slnnr <br /> DEPARTMENT OF ENVIRONMENTAL RESOURCES <br /> III 3800 Cornucopia Way, SLrrte C, Modesto, CA 95358-9419''- <br /> Phone: 209.525.8700 Fax; 209 525,87 =1 <br /> my I <br />{ ll...ino!d a, In. d,ll . <br /> 7 <br /> I <br /> I, <br /> SEPTIC TANK PUMPER DISPOSAL REPORT <br /> FOR THE MONTH/)'EAR OF <br /> i <br /> 4 <br /> I <br /> DISPOSAL SITE (Please Snow Address): <br /> BUSINESS NAME MONTHLY TOTALS Gok)i7s <br /> ADDRESS I D NUMBER —9qO _ <br /> TANK CAPACITY= _ <br /> f <br />