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ONE■ RECEIVED <br /> 0% <br /> 0:0 DEC 0 5 2017 <br /> ENVIRONMENTAL HEALTH <br /> PERMIMER)ACF4. <br /> DEPARTMENT OF ENVIRONMENTAL RESOURCES' <br /> 3800 Corntic"is Way.Suite C.Modesto,CA 91173111844414: <br /> Phone:200.525.6700 Fax:208.523.67 74 <br /> (LIQUID WASfffR40_CLR MONTHLY DISPOSAL REPORT <br /> ;............................................................................ <br /> ............................................................................................................................... <br /> .......................................................................................... <br /> BUSINESS NAME: j A-1 Septic Service <br /> COUNTY REGISTRATION NUMBER: 1891 i <br /> ADDRESS: ;6619 Woodiand Ave I TANK CAPACITY. <br /> -- <br /> Modesto,CA 953SB <br /> ------------------------------------- <br /> ------------------------ ---------------------------- <br /> REPORTING MONTH YEAR: <br /> Nov-17 <br /> TOTAL GALLONS PUMPED THIS REPORTING PERIOD: <br /> 50000 <br /> DATE OF DISPOSAL <br /> SERVICE CUSTOMER NAME I STREET ADDRESS CITY 1 WASTE TYPE. FACILITY NAME <br /> or SITE ADDRESS <br /> 111/1/2017 Brian Patel ___45O2�4 Rohde_____.Ceres Septic City Of Modesto <br /> 2 11/2/2017 Arron Miller 9612 Silver Fox Oakdale —TSeptic City Of Modesto <br /> 3 11/3/21017 Robert Berr 1604 S Alturas Modesto Septic City Of Modesto <br /> 4 11/7/2017 -lose Euenrostro 11624 Vivian Modesto Septic City Of Modesto <br /> 5 11/7/2017 Ci <br /> _Ejudy Baca Oakdale Of Modesto <br /> 6 11/8/2017 Br an Duco 11818 Vivian Modesto Septic City Of Modesto <br /> 7 11/10/2017 Tim Mckensev 230 Ike Crowsland'no Septic City Of Modesto <br /> 8 11,113,12017 Andra Sill 110642 Pei lerin Waterclord Septic City Of Modesto <br /> — <br /> 9 11/14/2017 Steve Willson 9313 Sawyer Oakdale Septic City Of Modesto <br /> .10 11/15/2017 Edd Brown 15191 Orangeblossom Oakdale Septic City Of Modesto <br /> 11 11/17/2017 Monica Barocio 1729 Ohio Modesto j Septic City Of Modesto <br /> 12 11/17/2017 Maria Azevedo 5454 VV Keyes Modesto Septic City Of Modesto <br /> 13 11!2012017- Mike Beckwith 1700 Swalls Modesto Septic City Of Modesto <br /> -- ------- --- <br /> 14 11/20/2017 Miguel Villalobos .2943 Curtion Turlock Septic City Of Modesto <br /> 15 11/21/2017 Dustin Mcgregor 13042 Blue um Modesto Septic City Of Modesto <br /> !Attach additional p,a,g­e,s'a,s'n' ece*s,s*' <br /> ,F"&16\5HFORMet.-CuldWA610Y.!CUIDWASTE HAI-JLSPMO!4THLYDILPIOSALRSPORrXliX • <br /> IG 111/27/2017 Monica Barocio 11729 Ohio Modesto I Septic City Of Modesto <br /> 17 11!28!2017 Maria A-7evedo Modesto Se2ptic <br /> 11728!2017 Mike BeckwithSwalls Modesto IS qptic City Of Modesto <br /> 19 1112912017 Miguel Villelob s 2943 Curtion Turlock eptic, City Of Modesto <br /> 20 11/30/2017 Dustin Mcgregor 13042 Bluegum Modesto Septic City Of Modesto <br /> 21 11/27/2017 Andra Sill 11460 Hazeldean Waterclord Septic Ci tv Of Modesto <br /> 22,11/28/2017 Chad Wright 15612 Chenault Modesto Se tic City Of Modesto <br /> 23111/28/2017 Caroline Sullivan 1402 Stockton Modesto ISeptic City Of Modesto <br /> 24 11/29/2017 Nicholas Te""eda 1921 Kenneth Modesto <br /> Cjity(:�f_Modesto <br /> 25 11/30/2017 Gary Texera 15525 Parker Modesto Septic City Of Modesto <br /> 26 <br /> 27 <br /> 28 <br /> 22-9. <br /> 301.......................................... ......................... ............... <br /> Received Time Dec. 5. 2017 11 : 17AM No. 2676 <br />