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V ct Vo l u 11:518 11110 ybL-4U 1-"I OU p"L <br /> Pai cel number: Sysmrn status. ❑Con.pliant Nancompliant <br /> ias*lIvrniner!byNo hrm) <br /> Tank IrstogrKy and Ssfatty Compliimice <br /> Compliance Issue#2 of 4 <br /> Oath of Qoserve6n: Reason for obsetveton: y`1�.':�-�.�n;1 r c '•-�,,#n <br /> 1:h1G form expires on(ffttee yGB4 r` <br /> Cctnplfanos guestiorfslcrtl aria.(Required) flet t�lttlQrt�8t#ttv3":�t3Atltxtal) <br /> _�. rchai*the a9PPMP6ffa bg . <br /> (Chock the apprapr:ate bdx,) <br /> P?ce8111e aystertr cWsist-of 8,560099a ph,, 1 my--$ Tic <br /> ss ti! lir tatairt !w? CI t'robed tank 6oitarti <br /> Do any sewage tankts)6ak belowthalr Q Yes •-Q iso Q Observ®d lour liquid level <br /> des!-or W vger;�g oths 0 -E=MI:,ed OOW! ttdion records <br /> Itties,tttarrtlty%Wch Wftge � Emmined amp's(pumped)tack <br /> Wk ark le lta. .— . L""j. Probed ouWa ankfor"buck soft" <br /> Any"yesusnsts writ trckat met the systm is fefting to protect f <br /> ggrQwrd%ww, Q Pressuiel wcuLm chaok <br /> ` Seepage pits m6ating T080..a3o may be compliant if allowe6 0 00er <br /> In grdir MMS by 10mi perm-TWnp euthority. <br /> --xO=f1OF8rd prott�Gt exists.T�wS list isnot exhaustive,in <br /> sequeniid order,icor'does if ftmYcale viltich cc-mb*oWns ' <br /> era srecassary to-ftehe Mrs dettni*Mt1bn. <br /> Safety Check <br /> Am attytrWifgenattca trate c;wts demrQW,•ta-ackW,or appeered to besG-uct:reJiy unsound? Yr.V 16No <br /> 2. <br /> Were-4ffsidenwxe We covera replaced Ina secured manner Mg.:all SOP.Ws replaced}? . Ig Yes Oto` <br /> 3. ' Wn secoWsly swess restrA t prassWL(safety pen.second oover.or ss»ty netting)—big*rs.ammiandod. ❑Yes 1 PNO <br /> G. was On 1 other SMI*/health WGL.e present? [t Yes' N� <br /> Esgsam: - l <br /> 'Syabm is-an fMM1H&)?t VWMd 1O pabric hearth and 80--'*tl/_ <br /> Cei'ii 7C>stion <br /> 'ihisfi9l�tt iato.ii�t�ornpiabd arxi>�chsd to t`ts St!,�rtary Ecrn aftns i►A7niresotai Poi!trilon Cottrei Rganaf3{fi��'CA�-Gomc!lance • <br /> ins{rsettcrhjrmmjbr•Extstirrg Subsurkm SewagerTrsatmentSyatems.abserratrona.WeITIvII81WO,attd mmol rstors must be <br /> ampl�.L.y pen mow,makdatner,orstrrvtce provider.Compleind fain must be submitted-i�ttrs 1=1 unt of government-,� n <br /> hl <br /> 13 days <br /> Ptopt rtpOmertlame(s}: <br /> Ptnperty ad rss�: _ S -/ r,K�a¢,Z�,_e �` �'` '�•c� — = . <br /> Property ownaes address Cd sift"- . <br /> Cuunty: P, Phone: <br /> ftmbyc8iW that ipemonarlyinedethe observations, tnt'arpreiatlerts,and cmwJv3ft-,s rGROMLI07 VIM f rm end,thattheyaro <br /> catrsck <br /> Names Sy U 1 yam C:sfflicetion number. <br /> t3vstaess ttgsnss tzei.�a��+.,e+b:.: �:1 I r`�vG:�.� L�•���.•�-�� �<._. I 1 L.� or <br /> Nome of'loml unit of a --,----- <br /> S1Qnatt:m pate: 7 tZ`zr�•Z��„� -- <br /> s+�-}^rwissr�•r-3 i � c�mpttt�:�1nsGe�ilor dorm�crfxfs:tr�:S?'S . <br /> w r:r!uc <br />