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R <br /> '. <br /> flissB SEPTIC 503-393-1311 . 541-924-0851 <br /> SERVICE FAX 541-917-1861 • DEQ#38137 <br /> //�� Date 6 3/ 1 3 20 i q <br /> Name C c COI f,� <br /> Address 350 Jr e,\,.e..(-- a SS a-1�.`(�'� Or °Z'Sd2 <br /> -For Pt 1/4\i- lon orkfAr\ .\-- - <br /> TLJ .e--_.-- .008 Gc,-1\On s <br /> white-customer • yellow-office • pink-County <br />