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SAN JOAQUIN COUNTY <br /> m ENVIROd4h7IMAL HEALTH DEPARTMEHf <br /> Return this form by <br /> 300.Last Weber Avenue,3i6F[oor,9tocktam�CA95202-2708 <br /> CD the 12i t3feach month <br /> Tefgahone: (209)468-3420 Fax:(209)464-0138 ffW T -sjgov.orglehd p <br /> SEyP�TAIGE Cy�LEAINTER'S REPORT <br /> aa Company Name: f�UTd KLYJk9l9 Report for th oothof: ear <br /> 1 \ Y <br /> CompaOyAddrers: �}22� ASA rye �i� N, CIt;rL )C Signature: <br /> 3m AdG . Qty L'y CoE. <br /> All information submitted must be com lett atcarale, tad It ibit <br /> DATE NAM OF RUSINFS5 OR ADDRESS MIWM WORK WAS OONE (R) mivaxrut. <br /> r'I-AFD PROPBIiTI.OWNEA GALLONSpLPA6C 1NCLUDr STR¢iT N. DtarcTION, srxrrs xAue AN cl Tl' >'DEIPED (0) G%WFTaA° NAME OF TRBA7MEW <br /> = C cffawv11 PACiLJTY <br /> S 3'L6 yp� �0 0o- <br /> hoc sty Vii_ <br /> .� <br />�.. cqv2" <br /> • <br /> o ae6L o 20)S' ✓ a <br /> O Q <br /> P <br /> 110 1� e N <br /> 17 <br /> MAI, .c Qtf <br /> S-Il W 4 O <br /> b - 116N <br /> D N <br /> Mn s Lv- 12 <br /> m 3110 <br /> _ v LM 1Do 0 <br /> NS <br /> v 1tm ue On �2 v. o <br /> my N <br /> ND Qq <br />�i ERD 42-04 a > <br /> 8!30!04 <br /> m <br />