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Marion County <br /> <br /> OREGON <br /> CaOMMUNITY DEVELOPMliNT <br /> DEPARTMENT <br /> <br />28S Church Street NE · Room ~ 32 · Salem, OR 97301-~670 <br /> <br />~EPTIC TAI~K. ABARDONME1TT <br /> <br />TR~ S~TIC TAI~K AT: <br /> <br />WAS <br /> <br />DATE 'rANK PUMPED: <br />THg /~REMOV~D <br /> <br /> [ ] PILLED <br /> <br /> fora~ed <br /> %ion of <br /> <br />'/ /(lic~n~e~d'D.EiQ. pumpe ) <br /> ....... <br /> <br />the bottom of =he =nnk should be per- <br />or cracked to prohibi: ~he accumula- <br />surfac~ w&~er in the ~ank) <br /> <br />ENCLOSE A <br /> <br />MATERIAL: <br /> [ 3 REJECT SAND <br /> <br /> I ] CRUSHED ROCK <br /> [ ] OTHER, ..... <br /> <br />COPY OF T~E PUMPING RECEIPT WITH THIS FOP. M, <br /> <br />SITE <br /> <br />F!- E <br /> · <br /> <br /> <br />