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A & B SEPTIC SERVICE, INC. <br /> 7525 WINDSOR ISLAND RD, NORTH SALEM, OREGON 97303 <br /> <br />DEPT. OF ENVIRONMENTAL QUALITY LICENSE N0.33008P-1 <br /> <br /> LOCATION OF LID ~ ~'~.~-~- .... <br /> APPROXIMATE SIZE OF TANK:~gallon~ <br />TANK CONDITION? GOOD / FAIR CONCRETE ~4. OTHER. <br />ARE BAFFLES OR ELBOWS IN PLACE? <br />EFFLUENT PUMP__ P~p TANK DOSIN~ SYSTEM <br />DRAINFIELD WORKING SURFACIN~ SLU~IS~ <br /> NEEDS TO BE REPLACE~ <br />SOLIDS: NOR~L EXCESSIVE <br /> <br />REPAIR NEEDS: INLET__OUTLET~INLINE LID <br />HOUS~ VACANT ~ OCCUPIED <br />NUMBER OF P~OPLE IN ~OM~ PRESEN~ PREVIOUS~ <br />~B~R OF YEARS SINCE LAST PUMPIN~~~ <br />RECO~ENDED P~PING INTERVAL: ~~ <br /> <br />SIGNATURE <br /> <br /> <br />