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r _ MARION COUNTY PUBLIC WORKS <br /> BUILDING INSPECTION DIVISION <br /> 5155 Silverton Rd NE/PO Box 14500 <br /> Marion Salem OR 97309-5036 <br /> County (503)588-5147 <br /> www.touildinco.marion.or.us <br /> -Db3C lV S��`� <br /> HOLDING TANK ANNUAL PUMPING RECORD <br /> Facility Name: Household Hazardous Waste Facility Permit# <br /> Address: 3230 Deer Park Dr. SE Salem, OR 97317 Date: 2/25/2026 <br /> Inspection and <br /> Name of Alarm Test <br /> No.Gallons Ultimate Water Usage (confirmed <br /> Date Pumped Licensed Disposal Site (gal/day) alarm is <br /> Pumper working, <br /> yes/no) <br /> NA <br /> This report must be postmarked or received on or before January 15, 2026 to qualify for the reduced <br /> Annual Compliance Determination(ACD)Fee of$82.00. ACD fees for reports received after January 15, <br /> 2026 are$240.00. <br /> REMARKS:Facility was closed from March through August, only staffed 6 days per <br /> month when open. <br /> I certify that the holding tank has been operated the previous year in full compliance with the permit,and I <br /> am familiar with the information contained in this report and that to the best of my knowledge such <br /> information is true,complete,and accurate. <br /> Name and Title: Andrew Johnson Phone: 503-566-4184 <br /> Email Address: ajohnson co r.us <br /> Signature: Date:4 ��,C <br />