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vaL uv"XIIALU �,VUUIY —RAT-IJUALIGULai lJVAOjt 1 "IV131VIN <br /> Septic Tank and Cesspool Cleaners Report <br /> eJ� c�i g <br /> m COMPANY NAME: 7, r 5 <br /> '.COMPANY ADDRESS: <br /> REPORT FOR THE MONTH OF: y•-c ,20N ,79713 <br /> a _ <br /> DATE NAME OF PROPERTY AD RESS WHERE WORK GALLONS WHERE CLEANINGS WERE UNLOADED <br /> OWNER WAS COMPLETED PUMPED <br /> � _. l°,��, X96 h1l C/ <br /> w Y.A t v'-tat v, wCr C <br /> J <br /> W <br /> Q <br /> 2 <br /> O <br /> t1 <br /> Q <br /> 06Q <br /> o <br /> 04 LCl <br /> CSI <br /> CD <br /> V ao <br /> N <br /> M <br /> � m <br /> m — <br /> CV o <br /> cr <br /> N <br /> CD �— <br /> M I E <br /> m Return by the I2'k of each month to I CERTIFY UNDER PENALTY OF PL HAT THE FORGOING IS TRUE AND CORRECC. ~— <br /> Eoviroomeotel Health Division ., I a <br /> ,-i 304 Fast Wctrer Avenu J Floor <br /> StDmAlou,CA 95202 VATt- S GNA RE OF APPLICANT Z <br /> U <br /> SepRep Rev.12199 oc <br />