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Pump and Alarm Verification Form <br />Site Address: -;—;;, &go_C- � i / tle/- t1) if lam" L> I,- <br />Company Name: l�-cf77C'(I2 9.rc1-0)e1 Z G License #: L'3ge/ <br />That a representative or I of my company has verified that the Indoor or Outdoor Pump Alarm <br />sounded by lifting the float switch and the alarm light is on and that the pump was tested with <br />the float switch. <br />2. If applicable, that myself or a representative of my company has verified that the Indoor or <br />Outdoor Filter Alarm sounded by lifting the float switch and the alarm light is on. <br />Date: 7 —A &— �;zo �,- 2=- <br />Print Name: AO4zJ3 <br />Signed: <br />Please return a copy of this form to: <br />chris@midwestsewer.com <br />Final Inspection and certificate of compliance cannot be issued until this form is received. <br />