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_. /18/2008 11 :37 FAX 2098239095 [a 001/002 � <br /> Stasi ' 4DEPARTM� P' <br /> Phan 2 r r 774 's <br /> nfy <br /> Srrrvinp ry r. IAr 6•AI �� i <br /> I <br /> hr , <br /> SEPTIC TANK PUMPER DISPOSAL REP EN USED <br /> FOR THE MONTHIYEAR 0 <br /> { DISPOS L SITE (Please Show Address). <br /> b7_21 5`yG17 i4 <br /> I , <br /> BUSINESS NAM LL MONTHLY TOTALS qC0 Gallons <br /> ADDRESS -.-.+ I D NUMBER qr'A) <br /> TANK CAPACITY <br /> �Igpl20 <br /> DEPARTMENT OF ENVIRONMENTAL RESOURCES <br /> 3600 Cornucopia Way, Suite C, Modesto, CA 95358-9492 <br /> Phone: 209.525,6700 Fax: 209.525.6774 <br /> my <br /> 71rr+..rb o.IAP fill <br /> r <br /> SEPTIC TANK PUMPER DISPOSAL REPORT <br /> FOR THE MONTHIYEAR OK�//_W <br /> i <br /> DISP SAL SITE (Please Show Address): <br /> C,94 ge fti4W=A <br /> BUSINESS NAME, ��libehIMONTHLY TOTALS Gallons <br /> ADDRESS r I D NUMBER C) <br /> TANK CAPACITY- — <br /> , . , <br />