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/ State of Oregon Department of Environmental Quality /7—��D7< / —/' ' `� <br /> Annual Operation and Maintenance <br /> rill <br /> DEQ Report Form <br /> General Information (Complete ALL information) <br /> MARION AG SERVICE INC. Phone: 503-519-9240 <br /> Property Owner: <br /> Site Address: 18651 Westwood Ln. NE Parcel#: 042W250002600 <br /> City. Aurora county: Marion <br /> Permit#: 12-05159 Start up date if 1st year in use: NA <br /> AX20-1 B System Model#: System Serial#: 126996 <br /> Report Year: 2025 Date of Service Performed: 8/13/2025 <br /> Email Address: TOMW@MARIONAG.COM <br /> Onsite wastewater treatment system status: (Do not prefill and photocopy checkboxes) <br /> Yes No <br /> x❑ ❑ Was maintenance performed as required by septic system rules and the manufacturer? <br /> x❑ ❑ Is the system operating in accordance with the agent-approved design specifications? <br /> x❑ ❑ Is the system currently under a service contract with a certified maintenance provider? <br /> ❑ 0 Is the system failing? <br /> ❑ ❑� Discharge of sewage to the ground surface? <br /> ❑ ® Discharge of sewage to drain tiles or surface waters? <br /> ❑ El Sewage backup into plumbing fixtures? <br /> If you answered"Yes"on the last four questions,was a repair permit obtained? If not, explain: <br /> I certify that this report is complete and accurate to the best of my knowledge. I understand that falsification of this <br /> report is grounds for revocation of my certification and/or civil penalties. <br /> `Maintenance Provider Name(please print): Cory Morgan - A & B Septic Service <br /> `Certification#: M 587 `Certification Expiration: 3/28/2026 <br /> (`This line only can be out and photocopied.) <br /> Original Signae uu e. "\\) Date: 12/31/2025 <br /> Note: Maintenance providersxNst maint ate records of their maintenance contracts,customers, <br /> performance data, and timelines for rene contracts. These records must be available for inspection upon <br /> request by the agency per OAR 340-071-0130(24). <br /> DEC AneuR lepeiRtRen ane MRireeeRree Repml I orn Rev 62022 <br />