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4/16/2008 10:29 FAX 2098239095 IM002/003 <br /> StaAi - DEPARTMENT OF ENVIRONMENTAL RESOURCES <br /> 0 Cornuco I6 Wa 'Suite C Modesto CA 95358-9492 <br /> 380 r <br /> p Yr. <br /> Phone: 209.525.5700 Fax: 209.525,8774 ? <br /> lity F <br /> Sur•.np r- e. rn,6e7 <br /> SEPTIC TANK PUMPER DISPOSAL REPORT s <br /> FOR THE MONTHNEAR OF D <br /> i <br /> DISPOSAL SITE (Please Show Address): ' <br /> ­242z L6.2 <br /> j /tAA <br /> BUSINESS NAME /A• 4Ddvgt — MONTHLY TOTALS, qaL ) Gallons <br /> ADDRESS I D NUMBER W1,0 <br /> TANK CAPACITY &&Z7 <br /> Stun, I <br /> DEPARTMENT OF ENVIRONMENTAL RESOURCES <br /> 3800 Cornucopia Way, Suite C, Modesto, CA 95358-9492 <br /> Phone: 209.525.8700 Fax, 209.525.8774 <br /> Ivor nIfY <br /> Sin 4nr rr or Idr trr+l <br /> k ' <br /> SEPTIC TANK PUMPER DISPOSAL.REPORT <br /> FOR THE MONTHNEAR OF <br /> DISPOSAL ITE (Please Show Address}: <br /> BUSINESS NAME w r4D&hu- MONTHLY TOTALS Gallons <br /> ADDRESS I D NUMBER Cap- -w I' <br /> i <br /> TANK CAPACITY 2LiM> <br /> w <br />