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PROPERTY OWNER,~-~ <br />ADDRESS /~ <br /> <br />ADDRESS/LOCATION OF E~AI~UATION <br /> <br /> -To Be Completed By L~ensed Septic PUmper only- <br /> <br />COMPANY NAME Mike's Septic Service <br /> <br />DEQ LICENSE NUMBER 33519-P <br /> <br />SEPTIC TANK ~JATERIAI~ ~ CAPACITY OF TANK <br /> <br />,IS TANK IN Good CoNDITIoN? /YES NO <br />ARE BAFFLES AND ELBOWS I~ PSACE? ~ YES NO <br />IS DRAINFIELD BACKING UP INTO TANK? YEs / NO <br /> <br />-Di~gJ:am Of RoUSe Ahf[ Lo~i%ion Of T~hk- <br /> <br />I pumped and {)ls)}bc~ced EhJs'seP~c(c Eank ~ld founJ' cdhd{t(ons as noted <br />above 8s of this da~e~ This is a limited inspection and m'akes no guare, ntees <br />concerning~x~f.turec~p~/xperfOrmance of the syst~ ~ <br /> SEPTIC/TANK PUMPER <br /> <br /> <br />