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06 - 019IAaQ1 <br /> US of Ofmoan Department et Environmental Maley <br /> Annual Operation and Maintenance <br /> o Report Form <br /> General lnbnna on(Complete ALL Information) <br /> prapany Ownu, Mir Hussain Rom 5113-8004e78 <br /> Sae Adorer 3e0 Grandview Ave peon eeleis0C04100 <br /> ay, scoot Mftts county; Marbrr Cerny <br /> nennttt. 555-24OO2e73-PRMT-1 gyre up dele if le year in use 12)2024 <br /> system mods* Preeat+raDlsbtuton swim Seed el N/A <br /> flapetasn 2025 Os atSenta Manned: 12J2372025 <br /> Enemy Ad m MovaalemeareiLmm <br /> Onsit a wastewater treatment system status:(Do not prefllt and photocopy ctaakbooes) <br /> ma No <br /> IR ❑ Wee meeellerne pekoesd et cegtdnd by eeptla syalwn ride and ma rmnuhcturM <br /> ri ❑ Is the system oseustingh armdn an with maanacewptaeea deer a$edeatlanse <br /> rig ❑ karegreen awe*undue sanee"mmract web a caddied mehnsnance prSNdeR <br /> ❑ rsi. Ie the system tang? <br /> ❑ f3 Diedwysafaewapa b IS around arrfane? <br /> ❑ 0 Dt dotes of screw to again**orautaswablm? <br /> .r Sanaa bedoip Wa pe.aSna 8dwaa? <br /> If you segmred'er enlist mat forquesta*was a mpaw permit obtained? If not.waft <br /> I caddyamtade sport is Rape*and acuraea b the best dmy ktowkdpa.I Lrldsrstaerft6 feYltcdm of ads <br /> t to grounds for moutonn of my esdreaaon ewer dvrt pertatlec <br /> YMiNenuwa prouder Name(pleas pdn): Bennet sepac Service tie(Amber.Bennett) <br /> terpecaeon e_ RM245 to t aton FYp&aaoa: 0 2027 <br /> Ms arurady can be geed out andphamaaped) N x <br /> Otbinal tlanattae;� r. Dam: !� <br /> Noh:Mamkn.na provided awes maintain actuate facade cif lhamaintenance sa+mWa,customer., <br /> pitman date,and dfsWa farreawat➢are contracts. Than reuvds must be available farbepection upon. <br /> newest by ea soency par OAR 340A71-0130(24). <br /> DEO Natal and AaPatFan Aw..ana21 <br />