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PROPERTY O~NER <br /> <br />ADDRESS OF EVALUATION <br /> <br />-To Be COmpleted By <br /> <br />~eptiC PumP6~ OntyJ " <br /> <br />C01.1PANY flA;.IE I.like's Septic SQ~'vi~Q <br /> <br />oEQ LICENSE ~iU(~BE(~ -~-51gL'P 'i' <br />DATE OF TAflK PUt, PING 6 ' <br />SEPIIC TA~4K r, iATER[AL /~_~_~ <br />IS TANK IN GOOO CONDITION? <br /> <br />ARE.BAFFLES ANO ELBOUS IN PLACE? <br /> <br /> CAPACITY OF TANK /~ <br />~ YES NO <br />~YES NO <br /> <br />GALS. <br /> <br />IS DRA)NFIELD BACKING UP INTO TANK? YES <br /> -Diagram of House and location oF <br /> <br />tank- <br /> <br />~ , NO <br /> <br />I pumped and inspected this septic tank and found conditions as noted <br />above on this date. lhis is a limited inspection and makes no guarentees <br />concerning future performance of this system. <br /> <br /> ign'ature of pumper <br /> <br />FIL £ <br /> <br /> <br />