HomeMy WebLinkAbout901 Red Canyon Cr Rd - 194125102007 - 2015 Cleaners ReportE Cosa my System s C l an rs port] ng Form
(Please Print
Name of Systems Cleaner,
Name of Service Person
Date of Servi.ee
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Date of System Installation
Property Owner.
Property Address
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WIJ
Lot Block
Estimated Tank Sipe Q-50 0
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Tel e lion
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Tank Material
ofManholes � - Depth to M'anhole Covers
Estimated Volume Pumped 9 15�6 0 # of Compartments
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Sludge Thickness haches Scum Thickness
-
Baffle or Sanitary Tee in
Place Inlet 0 ut] et UNK
IMF
Effluent Filter in Place?
_( D_ _�D
Dosing Mechanism Pump _Siphon ("*Non
Dosing M lianisrn/Alarm Functioning Properly?
Higher Level Treatment System?
Previous Pumping Date, if known.
Location of Septage Disposal 14 i
General Comments i n l ode any signs- of failure and all
If Yes -Type
rk done 'in addition to pumping
inclies
Sketch (Location of Tank)
I certify that. to the be%t o ny k-im a Iedge. On above information is true and enfWd.
Signed
Date
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LCA � 71-6