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&. L.c. <br /> 7525 WINDSOR ISLAND RD, NORTH SAL[M, OREGON 97 , <br /> (5~) 39~13t 1 <br /> <br />D.E.~ LICENSE NO.~!OO~P-1 B.~. ~0.85~!} ~ <br /> <br />PROPERTY OWNER: ~A ~' ~/~ <br />ADDRESS OF TANK PUMP£9~ ~/~ <br /> <br />LOCATION OF LID '~ ~ <br />APPROXIMATE SI2E OF TANK:~~ GALLO~S <br />TANK CONDITION? GOOD~ FAIR~ CONCRE~E~~OTHER <br />ARE BAFFLES OR ELBOWS IN PLACE? YES.~ NO <br />EFFLUENT PUM~ ~ PUMP TANK ~ DOSING SYSTEM <br />DRAINFIELD WORKING ~ ~URFACiNG ~ SLUGGISH~O <br />SOLIDS: NORMAL,~/~ EXCE~SIVE~ <br />REPAIR NEEDS: INLET~OUTLET~,,,,.MAINLtNE~LiD_ <br />HOUSE VACANl~ OCCUPIED____ <br />NUMBER OF PEOPLE IN HOME: PRESENT ~ PREVIOUS~ <br />NUMBER OF YEARS SINCE LAST PUMPING <br />RECOMMENDED PUMPING INTERVAL:~ <br /> <br /> RECEIVED <br /> ~PR 17 <br /> <br />~b~iON COUNTY <br /> <br />SIGNATURE <br /> <br />OF PUMPER: <br /> <br /> <br />