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1l- 0og36' 1NQLj <br /> st•6sofomen ospaepnsnt of Envronnantrt Owity <br /> Annual Operation and Maintenance <br /> J) Q Report Form <br /> Genteel inforrnaton(Complete ALL bdermston) <br /> Property osrw Mks Niemeyer <br /> p : 503-41041725 <br /> s to MMese: 5243 Madrona HMOs Or prref p; 061. 01700. <br /> City: SAv®Mn Count Marini County <br /> pima.: 15-008288 SWt up den if IN yam In use 0412016 <br /> Bosun modem M2ORT14 _ system sweet 423510 <br /> R.prtYeer: 2025 Dale of Service priamred..12/l7f2025 <br /> Enact Mani.; Mkettelosfillbstrot <br /> Onside arastewatar ttsshnant system status: (Do not profit,and photocopy ctwekbottes) <br /> Yes No <br /> wi ❑- Wes maiMmum:a perfumed as rowed by'split mown n Nos end the mrededaur? <br /> r <br /> R [] Isto spies operandIn eooddsnae wen the apemrpprdwd designspadliparu7 <br /> ix 0 lathe syaem curse.*fader a service contract with a certified maintenance provider? <br /> ❑ f Este enfant IMine <br /> ❑ ® Disclaim dserapes to to ward surface? <br /> ❑ Okptasge ohewapem dean tees r.rfocevrdrs? <br /> ❑ =� Savage Iasdwp Into ptomain triunes? <br /> s you rwxarad'Yee•an the Last four queeduu,eras a repair pmN obtained? If not,calm <br /> r ay dui das Man Is creaNM end mutate In the beef of my Fnowisdee,t understand fhat_-realm of lee <br /> Marais wounds for iwacat n of my certloatonmdhw viva penalties. <br /> ireereenaeoe paovldr Harm{plena Out: Bennett Sepik Seneca llC(Anita Bennett, <br /> 'Cenple'ation RM245 'Crtemtan 6wimbere 03/d0,2027 <br /> tnrinswhamM . ot w�Ny <br /> °O&M ems `<1 / r .- % —30—'6 <br /> Note MaHenaance muskiest dust Reath avaate wont*oldie maintenance Canracea custdmra, <br /> prte'msp a data,end amines b tense%to ontam. Throe records mud be MSS tin:mai n upon <br /> request by the rgsncy port7AAte0-071-01 <br /> DEO Odious!Opesias rrdropacnr Rom Fenn Rm./67922 <br />