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6-•-cOo7 <br /> State ofOregon osperMunt of Environmental Quote/ <br /> Annual Operation and Maintenance <br /> xr <br /> DEQ Report Form <br /> General tnknisien(Compete ALL Inronnetbat) <br /> Property Owner: 51544#W4444/ per. 408-402-1109 <br /> See Attest t7BOSt pee. G61E15CD00101 <br /> city: cower Mine County: Marian County <br /> `Permit 53-23O022B8-PRMT Start upcflg 1st you lnuse 1212023 <br /> System Model it Ax2OR7-UV System Seal <br /> Report Year: 2025 Thee of Sergio,Pwtamed: 1212312025 <br /> Email Mean MemPearlatrnatcom <br /> Quits wastewater treatment t system status:(Oo not'refill and photocopy cSsckbotos) <br /> tYees No <br /> rR 0 wars aabemence performed as required by septic ayaum Mu art Po mMuhduns0 <br /> g ❑ IsYte Won cfsreieg In aetordansawah testenlePpmvaadeafpn sosetratandi <br /> 1:2( 0 to eve oyster)Durrett under•urea centred ebb a atednndrirenanoe tuaNda? <br /> ❑ El Is lee Maw fYLrp? <br /> ❑ z Discharge otsenna"to the ground salons? <br /> ❑ 121 Ethscherte ofeetehe 40 dmeitas ersuites eaters? <br /> ❑ SNAP Way irdo&Sins Sires? <br /> If you answered"Yee an enlost four gwreora.was a teak pent obtained? If not ocean <br /> I cattily that Iles report is comptelband woos to the bet of my Imot4.me I understand tate sl9maat antis <br /> repot a gran"tar too nstiorr of myoetilFwton amitosis periatyas, <br /> *Maintenance Provider Nana Must Wino: Bennett Bette Semite LW(Amber Bennet) <br /> ccsmsradone: RM245 Expiratory 0313012027 <br /> cries ins one con be a IrlprWJodi <br /> "Is Sknaaat !Z-3r,-�S" <br /> Notts Maistenenee Wonders must riatnaln account Mords atone r ma4Manance contra=sues, <br /> pertanwnee Pat end timeline.tor rennabto the artfl These wants must be evpiaba far Spsglcn upon <br /> nquest by to agency per OAR 3404fl-0150(24), <br /> OEO Resat Opuses,OW MSNnrnne Repot ram rein;WM <br />