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State of Oregon Department of Environmental Quality 0 vO07//V /A/z <br /> Annual Operation and Maintenance <br /> DEQ Report Form <br /> General Information (Complete ALL information) <br /> MARION RESOURCE RECOVERY FACILITY 503-390-4000 <br /> Property Owner: Phone: <br /> Site Address: 3690 BROOKLAKE RD. NE. 062WC18C01700 <br /> Parcel#: <br /> City: SALEM Marion <br /> County: <br /> Permit it: 555-20-004982- PRMT 7/20/21 <br /> Startup date if 1st year in use: <br /> AX2ON 142136 System Model#: <br /> System Serial#: <br /> Report Year: 2025 Date of Service Performed: 11/14/2025 <br /> Email Address: RICH@MRRF.NET <br /> Onsite wastewater treatment system status: (Do not prefill and photocopy checkboxes) <br /> Yes No <br /> D ❑ Was maintenance performed as required by septic system rules and the manufacturer? <br /> "❑ ❑ Is the system operating in accordance with the agent-approved design specifications? <br /> '❑ ❑ Is the system currently under a service contract with a certified maintenance provider? <br /> ❑ Q Is the system failing? <br /> ❑ MI Discharge of sewage to the ground surface? <br /> ❑ © Discharge of sewage to drain tiles or surface waters? <br /> ❑ II Sewage backup into plumbing fixtures? <br /> If you answered"Yes"on the last four questions,was a repair permit obtained? If not,explain: <br /> PONDING SEEN AT DRAINFIELD, BIO ONE HAS BEEN APPLIED TO IMPROVE THE SYSTEM. <br /> f 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: 3/28/26 <br /> ('This line only can filler ut and photocopied.) <br /> Original signature ✓ Date: 12/31/2025 <br /> Note: Maintenance provid: m - maintain a.,urate records of their maintenance contracts, customers, <br /> performance data,and time f. renewing t - contracts. These records must be available for inspection upon <br /> request by the agency per OAR 340-r - .1(24). <br /> JEQ Annual Operation;red Maintenance Henn'=_m <br /> Rep azozz <br />