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Septic Tank Pumping/Maintenance <br />Owner Informntion <br />Date: '7 Phone0 <br />: <br />0%%licr: I � i<12AQ1%L Email: <br />Property Address: <br />/S, <br />4 <br />As <br />Z56 7 <br />Owner's A(ldress <br />7&1 -3L19 <br />cif different) <br />i hereby certify that I have completed thrs work in accordance with Mali 7083.0770 rrit[I any local requirements. <br />No determinalion or guarantee of future system perfomance has been nor can be made. <br />Chip's Septic Service, LLC & <br />Swartzer's Sewer Services <br />16762 Babcock Avenue <br />Lester Prairie, MN. 55354 <br />(952) 200-3176 <br />chi pseoticna,ai l.com <br />Maintaner Signature <br />SSTS <br />License <br />#2064 <br />revised 12 <br />