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A~T~0RI~AT~O~ NOT~C~ $ SYSTEM ~VALOATION <br />1. <br /> <br />or; <br /> <br />Only <br /> <br />COMPANY NA~,: <br /> <br />D~Q LIC~NS= NO. <br /> <br />PROPERTY OWNER: <br /> <br />ADDRESS WHERE TANK PUMPED: <br /> <br />APPROXIMATE SIZ~ OF SEPTIC TANK: <br />IS TANK IN GOOD CONDITIOn? <br />liRE BAFFLES OR EL~OW~ IN PLACe? <br />IS DRAINFIELD BACKING UP INTO TANK? <br />If yes, explain; <br />S~PTIC TANK MATER~AL: Concrete Steel <br /> <br />NO <br />NO <br />NO <br /> <br />Other <br /> <br />DZAGP3tM OP HOUSE AND <br />LOCATION OF TANK~ <br /> <br />example: <br /> <br />IE <br /> <br />SIGNATUR~ OF PUMPER: <br /> <br />Rev 7/89 pb DATE 0F PUMPING: <br /> <br /> <br />