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SUU Last Main street Stocicton CA 952U2-2708 tlae 12"'of each month <br /> Telephone:(209)468-3420 Fax.(209)464-0138 ff'ab:www.sjbov.or8/elld <br /> SEPTAGE CLEANER'S MEPO T <br /> Company Name: Q `� ' kl\llN;avva1 tl -rP y11�eport in of ye61 ��� <br /> Company Address: rZ.e i_ ( Sigaeatu� . <br /> Street Address City_ Zip Code <br /> All information submitted must be cont le(t:, accurate, and legible <br /> DATE NAME Or BUSINESS OI2 (R) RESLI)ENTIAL <br /> AI)DRESS'4'i'IIERE lYORIC lYA5 DONT; GALLONS NAME OP"TREATI4IIJNT <br /> PUMPED PROPERTY OWNER PUMPED (G) GREASE TnnP FACILITY <br /> PLEASE INCLUDE STREET f!, DIRECTION, STREET NAME AND CITY (C) CRENIICAL <br /> ' l City <br /> Cit <br /> 1' ►1' `� I�YIC� -�Z � <br /> r. <br /> City <br /> � ,YCit <br /> 41D Cit t,,,�Y e l <br /> — <br /> r <br /> 10,rff O <br /> J 1 } `--, <br /> Cil• <br /> 1 ( ) cit LYS D <br /> Cily, V <br /> i L i ., / j' city, r` ` Ci 4, <br /> I sip <br /> I �U �/6- �1 -- clay <br /> tLid <br /> c) n City t <br /> �� I City lc <br /> X U ^L L ,C 0 t fo <br /> cin ' . <br /> cit•C'49 c \? _ I`— C`` yvf� <br /> Cit s <br /> city <br /> G}{ff A2.04 Sep6c/Ccsspool Rcport <br />