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Marion County <br /> <br /> OREGON <br />COMMUNITY DEVELOPMENT <br />DEPARTMENT <br /> <br />TANK AB A NDONTvlF~NT <br /> <br />THE SEPTIC TANK AT: <br /> <br />ACTIVITY NUMBER: <br />WAS PUMPED BY: <br /> <br />DATE TANK PUMPED: <br /> <br />(licensed D.E.Q. pumpe~ <br /> <br />(note: the bott0~m rforated or cracked to <br /> <br />THE TANK WAS: <br /> [ ] REMOVED <br /> <br />FILL MATERIAL: <br /> [ ] REJECT SAND <br /> [ ] BAR RUN GRAVEL <br /> [VI CRUSHED ROCK <br /> [ ] OTHER: <br /> <br />ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> <br />COMPANY NAME: <br />s, mE <br /> <br />DATE: <br /> <br />Marion County Building Inspection <br />285 Chumh Street NE <br /> Salem, Oregon 97301-3670 <br /> Phone: 588-5147 <br /> <br />abandon.tnk 5/96 <br />MC-15-S2 <br /> <br /> <br />