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x,r SAN JOAQUIN C;OURTY <br /> y°e...�C °c RECEIVED ENVIRONMEN'TAL HEALTI4 DEPARTMENT Return this furor by <br /> 600 East Main St;vet,Stockton,CA 952022708 the 12' of such month <br /> ' Telephone:(209)468-3420 Fax.(209)464-0138 Web:WWW.sjgov.org/ehd <br /> Lfa `p �l�N 15 <br /> 2ol` <br /> SEPTAGE CLEANER'S REPORT <br /> SUN �6_EV�'=z Resort far the mnnth of: _ year <br /> Q Company Name: 0NM _ �. <br /> FERMI NER FO SigIiatuJ.:3 <br /> Company Address: zip Cu&- <br /> Sirml Addicss City <br /> All information s1lhmitted must be cont lctc, nccuralC, And le ihlc <br /> DATE NA31fE Of BUSINESS OR <br /> ADDRESS WIIERR,WORK WAS DONE GALLONS (G] �REASETRAt' NAME OF�'TREATNiEmr <br /> PIIMpE,) FACILITY <br /> t'IJMPU:D l'ItOpERTYOWNER rl eAse lnCi.UDt 5l'RE:Y.9' e, DIRECTION, STREET NAM 6 AND CITY (C) fitEM![AL <br /> In <br /> Cit <br /> h <br /> CO _Cil -- <br /> O <br /> CV Cil <br /> Ci!y <br /> Cil <br /> v <br /> n Cit - <br /> Q <br /> r <br /> City <br /> CA <br /> -t-1 <br /> 0 <br /> t <br /> Cit <br /> I Cit <br /> J - <br /> Cit __.,. ... <br /> Cit <br /> O Cil <br /> Cil <br /> In <br /> ScptiolC;csgpuul Rcpwt <br /> C LE ID 42-04 <br />