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~.,, D.E.C. L:CE~SE NO,33008P~!,B.P,- N0.85813 <br /> <br /> ADDRESS OF TANK POMPED: ~'~__._~bF~-~ A~ ~-- <br /> <br /> LOCATION OF LID =~ ~CC ~ ~~C <br /> <br />APPROXIMATE SIZE OF TANK':.ZOCT~)~ <br />TANK CONDITION? GOOD ~ FAIR__ <br />ARE BAFFLES OR ELBOWS IN PLACE? <br />EFFLUENT PUMP,'1)D PUMP TANKS <br /> <br /> GALLONS <br /> CONCRETE_~ OTHER <br />YES_~ NO <br />DOSING SYSTEM/U~> <br /> <br />DRAINFtELD WORKING ~ _SURFACING /U'O SLUGGISH <br />$OL~DS. NORMAL~¢~EXCESSI\E <br />REPAIR NEEDS: ~LET_~ OUTLETOCMAINLINE D~ <br />HOUSE VACANT__ OCCUPIED~ <br />NUMBER OF PEOPLE IN HOME: PRESENI I PREVIOUS.__ <br />NUMBER OF YEARS SINCE LAST PUMPING /~-~-~ <br />RECOMMENDED PUMPING INTERVAL:~~D/K '~/ ~F~ <br /> <br />SIGNATURE OF PUMPER: <br /> <br /> <br />