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H11V3H 1V1NMN081AN3 <br /> MR 9T ]AP <br /> SAN JOAQUIN CO[TNCY Return this form by <br /> m ENVIROMiEN1TAL HEALTH DEPAR"ffiNT /� I �� the 12*of each motif It . <br /> (U 304 East\Veber Avenue.3`d Elonr,Stockton,CA 95202-270 ` <br /> m Tefrphorrc:(209)465-3420 F-=(209)444-0136 We&-,vww.sjgo�'.org/eh <br /> Q <br /> SEPTAGE CI_.CA]VER"S REPORT <br /> co <br /> a ___ . 0 f <br /> o- Report for the m th of: year <br /> e <br /> Company Dame: C & C portable Toilets, nc. _ — <br /> P.O. Box 1523 SigQuture: <br /> Company Address: Riverbank, CA 95367 Zip C.& <br /> All infermicli611 submitted must be cum lett rceurltc, rad le iblc (RI RUSIDrM -L NAMEOF7R7&TLIPXT <br /> &DDRLSS\EDRF,WORK WAS DONE GAI1 OK (G) cxr_A.MTRer <br /> O DATE FAAIF OF HUSIKESS OR CITY CJ [l1ECAfCAt PUMPED FACILETY <br /> N1'UMPF.D PROPgRTYOWNER pLCAS£ 1tNCLUDI STREET K, DIRECTION, STREET NAME A7:U r <br /> O City <br /> 00 <br /> m - <br /> O a 1y "� - <br /> N <br /> Ld <br /> W _ cin <br /> a n 5,12� <br /> Z u C`I c <br /> W <br /> / iA• C <br /> Ciry' <br /> �c1 <br /> rho /2Ce -- oily CY C ( A, <br /> +.) <br /> L c <br /> City I/ / <br /> o m CL <br /> lCL M <br /> JYvJ (]ty. �L <br /> U � .L <br /> Lo <br /> 114 <br /> Com - <br /> ` 1 a o CSD Cili, <br /> OrY - <br /> � m - <br /> [� Lin. . <br /> CiLy <br /> m — � 9 u`' i <br /> CN -- <br /> ` / cay a <br /> w > <br /> E[ID 42-04 <br /> W-M/04 <br />