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.. A & B SEPTIC SERVICE, INC.~ <br /> 7525 WINDSOR ISLAND RD. NORTH SALEM, OREGON 97303 <br /> (50'a) -~93-15! 1 <br /> <br />D.E.~ LICENSE NO.33008P-1 B.B. N0.858!~ <br /> <br />PROPERTY OWNER: <br />ADDRESS OF TANK <br /> <br />LOCATION OF LID <br />APPROXIMATE SIZE <br />TANK CONDITION? <br />ARE BAFFLES OR ELBOWS IN PLA'<E? YES~/~NO~ <br />EFFLUENT PUMP /'L/d) PUMP TANK_::~_~2._ DOSING SYSTEM ~ <br />DRAINFIELD WORKING_~/~ SURFACING ~, SLUGGISH <br /> <br />PUMPED: '¢,¢~.0¢'' ,/1¢'/~,.5 ('~,~ <br /> <br /> OF TANK:, ,,~ GALLO~S <br /> GOOD~> FA)R~ CONCRE~E¢~ OTHER <br /> <br />SOLIDS: NORMAL .......... EXCESSIVE~-~ <br />REPAIR NEEDS: INLET~--._ OUTLET~MAINL~NE~_ LID ~~7~) <br />HOUSE VACANT~ OCCUPIED_~/~ <br />NUMBER OF PEOPLE IN HOME,, PRESENT ~ PREVIOUS ~ <br /> <br />NUMBER OF YEARS SINCE LAST <br /> <br />RECOMMENDED PUMPING INTERVAL: <br /> / <br /> <br />SIGNATURE OF <br /> <br />PUMPER: <br /> <br /> <br />