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^ ·. ,.c. <br /> <br />ADDRESS OF TANK PUMPED: /D¢'4 I¢0~ ~ <br /> <br />~OC~ONO~UD~~ '~ ~ ~"~ % <br /> <br />TANK CONDITION? GOOD ~ FAIR CONCRETE ~ OTHER <br />ARE BAFFLES OR ELBOWS IN PLACE? YES ~ NO~ <br />EFFLUENT PUMP ~5 PUMPTANK~DOSING SYSTEM ~ <br />DRAINFIELDWORKING ~,~ SURFACING ~ .SLUGGISH <br />SOLIDS: NORMAL ~4~ EXCESSIVE ~ 'OVER OUTLET <br />REPAIR NEEDS: INLET O( OUTLETO~ MAINLINE ~( LID <br />TI~ LINE -~ LOT SlZE,¢R*_NO. BR ~ HOUSE: VACANT~.OCCUPIED <br />NUMBER OF PEOPLE IN HOME: PRESENT ~ PREVIOUS <br />NUMBER OF YEARS SINCE LAST PUMPING ~-I~-~ <br />RECOMMENDED PUMPING INTERVAL: ~ P~ ~ <br /> <br />SIGNATURE OF PUMPER: <br /> D.E.Q. LICENSE <br /> <br />B.BNO. 85813 <br /> <br />DATE: <br /> <br /> <br />