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t <br /> w, Y I;NVIRc)NmF-KwLEtEALTH DEPARTMENT RetRI'll this forin by <br /> 304 East Webui Avenue,3`Eiuot, Stockton, CA 95202-2708 the 12"'of t iacI1 11101101 <br /> Talaplrolle:(209)469-3420 Fax:( 09)464-0 'eb.` -ww,sjgou.argle <br /> LL �Vis' t3 S {f %v <br /> SEPTAGC CLEANER'S REPORT �'.��• G :� '"� <br /> Company [Vance: Q Report for t[1c Clt oC year <br /> Company Address: <br /> 175ignalure, <br /> p' Strret Oddi <br /> City zip CoAc <br /> oAll leformittion siaimiited must Ge coot Ilett, accurate auL1 le ihlc <br /> 1 (A) RtsmenTlxL <br /> ~ <br /> DATE f4 it1(U OF BUS�I;SS OR ADDRESS li`tlE17F,l}'OR[Cli'AS DONE GAJ_.Ld[`t5 [�tLA'1ls OF 7•i[LrlT(44�NT <br /> MA-1PF.D PRo l'ERTY 01NNLlt LD (�1 GpJ-AsKTMp <br /> PLEAS9 IHC1,11UE STREETF CILICi' <br /> H, UIRIKETTON, STREET KANE AND CITY PUMPED <br /> (CI C1mhucAL <br /> - <br /> �c4 , City <br /> ti City <br /> �O 10 0 L 7 t� rr V-"- �J <br /> City <br /> Cuy <br /> �� ^L. JI ,,� /f L�• Ly <br /> city <br /> '170 LI �l Lt J� c 1 <br /> City <br /> My <br /> City <br /> City <br /> LL <br /> tty <br /> E ( 11 t_ <br /> tr - <br /> � City <br /> CISc <br /> m City <br /> w _ <br /> 3 Cit' <br /> 1 <br /> E <br /> O <br /> LL city <br /> city <br /> E <br /> Q <br /> City <br /> 4 ' <br /> CiLy <br /> 1 <br /> CLty <br /> o <br /> 1 <br /> Cil4 <br /> Elio 42-04 <br /> W30104 <br />