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01/042009 10:54 FAX 2098239095] I002/002 <br /> V, f <br /> Slam ► DEPARTMENT"OF EN ONMENTAL RESOURCES <br /> 3800 Comucopla Way, Suite C, Modesto, CA 95358-9491 <br /> Phone; 209,525.6700 F,5x; 209,5?5.677 <br /> r7'f y <br /> C <br /> I <br /> SEPTIC TANK PUMPER DISPOSAL REPORT <br /> I• <br /> r'OR THE= MONTHIYEAR OF 0(� <br /> DISP SAL SITE (Please Show Address), <br /> SUSINPSS NAME MONTHLY TOTALSC25, ,Galic�ns <br /> ADDRESS _ _ I D NUMBER 9qD <br /> TANK CAPACITY_ <br /> 5r+a1ll <br /> DEPARTMENT OF ENVIRONMENTAL RESOURCES <br /> 3800 Cornucopia Way, Suite C, Modesto, CA 95358.9492 <br /> Phone: 209.525.67'00 Fax: 209.525.b71': <br /> k d.,,nfy <br /> SEPTIC..T. .ANK PUMP=R DISPOSAL. F =FOR7 <br /> — <br />{ FOR THE MONTH/YEAR OF A)(00 <br /> DISPOSAL SITE (Please Show Address), <br /> ► j <br /> Q3_SW tiAVY ` <br /> BUSINESS NAME GJI. a n!y MONTHLY TOTALS /00 Gallons <br /> ADDRESS 1 D NUMBER <br /> TANK CAPAC7Y <br />