HomeMy WebLinkAbout19363 Hwy 6 - 168908200002 - 2024 Pump ReportEagle County OWTS Systems Cleaners Reporting Form
NOTE: Required to be submitted to Environmental Health within 10 days of cleaning an OWES
system
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EAGLE COUNTY Systems Cleaner Company 1 (11 V rV t'1 l License Number
Email Address �t2 V )il IMF Phone 1 Z -�►a�f
Service Technician AcMP.ZV Phone\ rI Tax Parcel# Address
1ofService IgO�,A iVl3 `�Qj � CC
Person Requesting Service L\f+!/t\ �t7�i ((D I Wg Phor����\O1,3)-a^ c7-3 4� SQL iT oKO
Property Owner A /I Phone
Septic System Permit
Date of service
Tank Size
Tank Material `PIAaIL
Sewage Disposal SiteU�k A uA & V-4 5
General Condition and Functionality of the System Ms> 41
Recommended Repairs /� 4
Site sketch showing location of the septic tank access lids measured from at least 2 fixed points
(Photos Encouraged)
Signed �^ - /� r Date