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7525 WINDSOR ISLAND RD, NORTH SALEM, OREGON 97303 <br /> (5O3) 393-1311 <br /> <br />" I 'r <br />D,t_.~~:CEASE NO.~.~OOBP-1 B,B. N0.8581~ <br /> <br />PROPERTY O~.'/NER: .('?'D~.O~ gol~,~.,,~'' <br /> <br />TANK CONdiTION2 600g~ FA]R~ . CONCRETE ~OTHER <br />ARE BAFFLES OR ~LBO~S ZN PLACE? YES.~O <br />EFFLUENT PU~P~,,~, PUMP TANK~ DOSING SYSTEM~ <br />DRAINFIELD WORKING. ~ SURFACIN~ ~D SLUGGISH <br />~OLIDS~ NOR~AL~~ ~C~SSIVE~ <br />REPAIR NEEDS~ I~LET~ OUTLETD~MAINLINE~ LID,~ <br />HOUSE VACANT~ OCCUP,IED~ <br />NUMBER OF PEOPLE IN HOME~ PRESENT PREVIOUS ~ <br />NUNBER OF YEAR8 SINCE LAST PUMPING~ <br />RECOmMEnDeD ~PING..,,~ INTERVAL:~ <br /> <br />iIF. I IVED <br /> <br />SIGNATURE OF <br /> <br />PUMPER'. <br /> <br />/J'T <br /> <br /> <br />