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1 <br /> a5-9nct�� <br /> Ncomm.1 <br /> BUILDING INSPPLTON DIVISION <br /> 5155 SBratoo Rd NE/PO Bat 14500 <br /> Wee OR 97309.5136 <br /> J (s93)Seu147 <br /> www.amumuloaerm <br /> 0.14/ct11K <br /> HOLDING TANK ANNUAL PUMPING RECORD <br /> Facility Name: ( &E EXCCWC Hn3 Petmit8 <br /> Address: 3511-I I ang,[d8 pate: Z(14 1210 <br /> a Inspecties and <br /> Alarm.Test <br /> No.Gallon Licensed Name of Uaimate Water Usage (confirmed <br /> Date Pumped Disposal Site (gal/day) tun.,a ga is^ <br /> Pumper <br /> porting, <br /> yeshm <br /> t��2S 2m li$'stp11L Eta o IA-t-51 <br /> 21312.5 2.,Zb0 <br /> 210125 2,400 <br /> 316125 21460 <br /> - - ----- ------_ - -- - 31rn126 21500 <br /> 313t12.6. 3.80D <br /> Htaa\2 , 2.260 <br /> 4124125 it1a60 <br /> 502425 trot <br /> 61z42125 Zs;gap <br /> tot Mg 2icen <br /> 412312.c. t,F60 <br /> 4t4tt5 2.400 V/ Nt/ \J <br /> " 14125 /aura <br /> This report mum be pwtroa td or received ea of before January 31. 2023 to qualify for the reduced <br /> Amoy Compliance Determination(ACD)Fee of SNI.00. ACD for for reports received after January 31 <br /> are 3240.00. <br /> REMARKS: <br /> 1 certify that the holding tad has been operand the prcviom year in MI compliance with the permit,and <br /> am familiar with the information contained in this report and that to the be of my 'muwledge sick <br /> mfmmalM is one,complete,and amnia <br /> Name and Titic:attract.Maur )tdwnIsfr4 Wt Assa4vArp ,pa1.424-asr( <br /> Frail A_$ ihstfinA.i I.ca.v <br /> Si Date 2I1212t. <br />