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A B SEPTIC SERVICE, INC. <br /> WINDSOR ISLAND RD. NORTH SALEM, OREGON 97303 <br /> (503) 393-1311 <br /> <br />D,E.~ LICENSE NO.33008P-I B.~, N0.858!3 <br /> <br />PROPERTY OWNER: <br />ADDRESS OF TANK PUMPED <br /> <br />LOCATION OF LID ~K~ZP_~.¢~,~. <br /> <br />APPROXIMATE SIZE OF <br />TANK CONDITION? GOOD C~.~ FAIR__ <br />ARE BAFFLES OR ELBOWS IN PLACE? <br />EFFLUENT PUMP~__ PUMP TANK/~r7 <br /> <br /> GALLONS <br /> CONCRETE.~_~ OTHER <br />YESES5 NO' - <br />DOSING SYSTEM ~ <br /> <br />DRAINFIELD WORKING_y.~ SURFACING ~ . SLUGGISH <br />SOLIDS: NORMAL__ EXCESSIVE_~~5 <br />REPAIR NEEDS: INLETD~__ OUTLE~O~ MAINLINE~__.. LID~O~,~ <br />ROUSE VACANT OCCUPIED~ <br />NUMBER OF PEOPLE IN NOME:--~ESENT A~ PREVIOUS....~. <br />NUMBER OF YEARS SINCE LAST PUMPING~O.~_u~J~___ <br />RECOMMENDED PUMPING INTERVAL:~~~ <br /> <br />OF PUMPER: <br /> <br />SIGNATURE <br /> <br />DATE. <br /> <br /> <br />