|
. '
<br /> FROIi : Panasonic FAX SYS7EM PH(3NE N0. : 612 753 6222 Aeo, il 2PJ32 Ii:iE�AM P3
<br /> Parce!number, 1U-111•23-21•0008_,�,_^___.,�,_� 8ystem s�tus: �Canplfant �]NpncomQlisn! �
<br /> . • ras determtned byih�form) �
<br /> �yf[rau14�perfor�n�n��s�nd dthar Cnmpll�na�
<br /> CnmpNance Issue 111 af 4
<br /> E�ate of afne�wrflton: 1�lp3112 ._,,,, Fte�s4n for nbeatvatlan: �alnt ot aate
<br /> 7ht5 farm expirea upon next in3p9clton or in thres,y�rs,whiohever ocqire frrar. �,,,� '
<br /> Compiianas que�danslcr(terlac t�equlre� ' v�f►�ae�on Met�a�":{o��on��y
<br /> �4heok fhe aapmpJfat box ,,,t,_� •{Cheok tha ApJ1�pp�iste box)
<br /> t)oea ii�e s atetrl dI80h�t�e sswe fle to the L;Yes �I�a (� 8eerohod for aWfaoo outkt
<br /> we
<br /> AtOund au a4e� .
<br /> Daes kfi$eystem dlsoheqte eewege�o drafn (�;Yes �J iVo C� Pertotmed hydreullc tost -
<br /> f�or surfaoe ars� . _,,,, • � SoarahRd for seepin8}n y�rd
<br /> Qoes th�9y�tvm�use sewwFspa t►npkup w. Cf{Yes �A!o � Ch�oFced tor backap In ho�r►a
<br /> I�s dwaRlna a ostabllshment9 �, ❑ �iCQg9jVe�dl�g I1i sp0 Ey9tA111/L�.�ibXB6
<br /> Qo oiher alluaUa�oxlsl ti�ei haVs Ihe ^ CI;Yae �No � H��er E4eUmnny .
<br /> pokentipt to immed►ately a►�d advatseiy
<br /> fmp�ct ar threotnn pubNa healih ot'esteiy : (� OtemSned fdr surginp In tqnk
<br /> �e,,,et:trk;83,ansate oCYel's�eta 7 , ,
<br /> Any°y�a„onswar thdloatea that thesyafem 1�ari Immh�em ' Q 81aok sWl'nboVe oolt�ispersal systeln
<br /> t6roat t�1�ubUo hoaTth ond ealoty. � L� �ystom raqufrea'emerflenoy'pumping
<br /> • - �-- 1� PMfarm�d dye t4�t
<br /> Doos ltt9 byatem pose a thl�eat tb 9t�puf�d [];Yes �!Vo ❑ C�h9r.
<br /> wAter for dry�odpclfltone deem4d nan- •� �•
<br /> .PrqtedNe es ddtetmt ed b the(n8 eatoft ._.^,Yn. w
<br /> "Yoe"1ndlca�Q�thaf tha aystom!�,f�lling to prQlvot
<br /> grouna wafar:Jt"ys�;descrl,Gs th�cond►von 1�otad: """�`�""' -"
<br /> ' '"NIO�Afld�d pfnlaco/9X(�18.7Ms Ilsr 1a�m!oxh�usrJva�
<br /> ' _... Lt sequeMlal oro►e�,aordoeslt di�7oe�e whkVt
<br /> ��,� ' combinaNvna oro nec9seary to rnoke tl�ls datom��i�sthn.
<br /> ---.,.�.,..�.----�.,,... . _....._..._.—_..
<br /> Certiflca�ton
<br /> Thia lam�la to ba Compl�tai and attact�ed to thp�nmmary�am of tho MlnqesQta�PdluUon Cantr4l Aqoncy's(MpCAj Cosnp3laflc�
<br /> InepeWian pom�tor Exleting SuqautfaCo 8avr�ge i?eaLnont SyaEama.Abse�vattoue,IMer�rel�dkme,end conClustvns must iw
<br /> Gompieted by en inspecEor.Gomp(nked fwm tfi►IAt Yrx eubmAteci to th�ic�l unit ot governm�nt wtihth 4a tl�ya.
<br /> Prop8lq�ownor rp,me(sj: Fide1 .1i1$I?�atlohs&Congulting -- , -
<br /> .,w.--.,.�..--._..�__..
<br /> proper�sddras�: �18&French�.ako Rn�sd�or, qn�,MN Bb391 .��,
<br /> Propeny w�mara a�ctreea�rduror�nq; G2o�ackeornl9e Road,8utte#2od,Vyarmineter,RA 1A974
<br /> . County. e ne In -- - -- - ...... Phoi� NA .,��
<br /> 1 h9reby oslilfyll��I pp�otrplly mado(ha�obaon�ellong,!»/nlpl�taBona,�rd cwnah�alolte ropated t�n tbla tant und fAei Utey4re
<br /> OG!'J1DOf� � f
<br /> Nrxna: Ma Tradawall � � �erNBcsltot►number. {1230j3� ---
<br /> 'Businecs Itcanse��anle end numbsr. 7radewell�I TegUr�p,�30��:. �r
<br /> . ..�......—,,,,.._-
<br /> -Nama of locql unN oF flova en� c,{t� of arvno „, �M�� ;
<br /> sl�nuEure: t^�"'�i,�� �'�;� , Date: i2l„�j1�. ,�.--�—_ �
<br /> . . . . - . . .. � , . ,,,- _. . , . �.__..__._. _ � . • }--
<br /> s'� ���'�,- -
<br /> . . ���_ _ 4� .
<br /> . , � �;
<br /> y
<br /> , ��
<br /> �
<br />
|