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JO f su f� <br /> RECEIVE® <br /> N <br /> m <br /> SEP 09 2-1A <br /> CITY OF MODESTO EMARONMENTALHEALTH <br /> Public Works PERMIT/SFP%Ar-r"1221 Suter Avenue,Afodesto, CA 95351 <br /> Environmental Compliance Section Pty:(2A9)517-6377! Fax:(209)577-6290 <br /> LIQUID WASTE HAULER MONTHLY DISCHARGE REPORT <br /> w <br /> U <br /> H Business Name: A-1 Septic <br /> 7 <br /> Reporting Month; Aug-13 <br /> w <br /> 0 <br /> Y Section 11 of your Liquid Waste Hauler Permit Conditions requires that you provide the following information to the City of Modesto Water Quality Control Fawlity each <br /> Q month. Please print or type the requested information and submit to the above listed address no later than the 16th day of the month following the reporting month. <br /> Failure to submit this report will result in automatic suspension from the City of Modesto Wastewater Treatment Facility. <br /> Q <br /> Q <br /> Q <br /> Stamped Ticket Waste Type <br /> Entry Customer Dame Check Box Street Address City Driver flame Dane Ticket Reference (Septic, <br /> Number if Business (at WQC plant) Dump Number Portable Toilet, <br /> Time or other) o <br /> f � o <br /> 1 {Susan Roth 7345 Belbs Modesto Dustin McGre or 2-Au 8:071 Septic <br /> 2 Lisa Edger 631 Tim Bell Rd_ Waterford Dustin McGregor 2-Aug f 13:18 Septic z <br /> 3 � <br /> Francis Dee 912 Colorado Mi)desto Dustin McGregor 5-Au 12:44 Septic <br /> 4 Dertis Cash 11367 Valley Oak Oakdale Dustin McGregorf 7-Au 12:17 Septic o0 <br /> N I <br /> r- 5 `Davis Guest Horne X 1552 Ohio Modesto Dustin McGr or 7-Au 14:47 Septic m <br /> M 6 <br /> CSD Nicole Blocher 8343 Kelman Modesto Dustin McGr or 9—Au 13:59 Se tic o <br /> r Nicole Blocher 8343 Kelman Modesto Dustin McGregor 9-Aug 17:38 Se is <br /> rn <br /> 8 Ashley Gould 10012 Del Arnendra Oakdale Dustin McGregor 13-Au 12.58 ISe tic Q <br /> 9 Monica Arellano 1404 Lambeth Modesto Dustin McGregor 13-Au 15:5 t S is <br /> CD <br /> f0 Jim Poore 5818 Chenault Modesto Dustin McGregor 14 Aug 12:44 Septic <br /> ro — <br /> m <br /> N a <br /> \ a� <br /> O'� a <br /> CD — <br /> � m <br /> O� v <br /> CD a� <br />