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SAN JOAQUIN COUNTY <br /> f`Y ENVIRONMENTAL F'MTH DEPARTMENT Return this form by the <br /> 600 East Main Street,Stocldon,CA 95202.3029 12t of each month <br /> Telephone.(209)46&3420 Fax:(209)464-0138 Web:www.sjgov.argfeFld � � �l! <br /> SEPTAGE CLEANER'S REPORT <br /> Company name: Reportfor the rn h of: ear <br /> Comps ny Address: 60 0 Gt lficeS M 939/0 Signature: ! air S <br /> SUM Address <br /> C4 zip code <br /> z <br /> All Informatlau submitted must be cola fete, accurate, and legible <br /> DATE NAME OF'BUSINESS OR ADDRESS WHERE WORK WAS DOME GALLONS (R) I�s1oEN7tat NAME OF TREATMENT <br /> PUMPED PROPERTY OWNER ESTREETPUMPED (G) (MASE TRO FAMUTY <br /> PLEASE 1HCLE STREET /, DIRECTION, STREET HAIRS AND CITY LC) <br /> aria �� G e w a/ en 95,3 50 <br /> UZ U.r sP <br /> 2 Ltd 1u1 d� CA 9523 .3 <br /> C dG�I Z fi11 . GV a D C 5 S <br /> drt r� -e 01 okgs � <br /> a <br /> 6021 U). <br /> cit, <br /> r1 0 [ CN Roo CA 9SE3� <br /> z <br /> k,111101'9 o o a Am C c CA S23 <br /> UCA qS �5 <br /> awlCft'qS <br /> y� r va o � • s 5rq <br /> s 5 0 v n ti 4 uj H of <br /> o LC40 w L <br />,1 ` ollco 'vS Z Uj t i-1 cftv 1 Qt7`C - IS <br /> O U /35 <br /> 0 c7s (1(Q`Q ow C 0 a tACISZ <br /> 0( 021 <br /> U <br /> a . . EHO 42-94 <br /> 1CAW SEPTAGE CLEALNM REPQFtT <br />