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� � o Authorized Distributor For
Schirmers Wastewater Treatment Systems, Inc. MULT/�FLD
AERATION EQUIPMENT
SALES & SERVICE
GENERAL INFORMATION
OWNEF7 LO LS YYl A''��i fi��.1�1L� RESIDENT
ADDRESS �T S�, S'�'�1 �l� 1-�1 L�L. '� , tr�i..f v COUNTY 1-�-�'f-1� •
U/1TE OF INSPECTION � a'- - � �'� PHONE `�� � - 1 � 3a
UNIT INFORMATION '
TANK NO. I TYPEOF TA�iK �� NO.OF MOTORS J SER.NUMBER �• a � ��
CHECK LIST U OO 1O O
Iten Da+s Per. Soeca, lieed Attn:
Ta4s MIxe�J 11quor saenpie � � OO O O �O �
CF+eek Alsr+n System 3
Turn Of f Pa+er OO I OO
Rtrne Surq� Bo�+l � � O 9 n O p O
Inepa.�ct Elfluent O��ality 5
•� v
Vaaxrn FIe1r snd F1•ltsn � O �� /�� 1� s
Nrsh f 11 ters -^ O
Insp�c!/Replace Top Gasket �
ina�tlRrtplace Bottorn " —y /
1�apect slar�n Sensors V �✓ O 2 O O 'O O
fnspect 11erator � O O O O
lurn Pwer On �
CURRECTIONS RLCOMMCNUEU: REPLACE�FILTERS�
�uLL� �� � W�— REPLACE EXPANDERS a
���t�ca� 50�4�P •
�
' COMMENTS
TESTING INFORMATION
IN FIELD TESTS TESTS IN LABORATORY
F�E1 TEMP _ B.O.D.
D.O. D.O.
C.O.O. __ FECAL COIIFORMS
SfTTI.C/1BLE SOLIDS 96 --. SUSPENDED SOLIOS
__.�!= �' ��" - LICENSE NUMBER �g� —
SIGNATURE OF SERVICE OR REPAIRMAN
WHITE�Health Depl. YEIIOW�BI11ing Ffte PINK�Maintenance
V
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Al1ULT/�FLO ���'� v`��
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INSTALLATION REPORT
DATE INSTALLED `7� — 4—�� GP� SIZE �B 0 SERIAL N �o� �1��
OWNER/USER LO 1 S 1�AY-�' b il�,��_Yl-'p PHONE N y '� ��_I � -� L2
ADDRESS: Street �1�1 5�''Qi�9��,� N'1.�-�-- �G�-
City ���'Z'�-'�� County �'��4-�� State �� Zip _�ss�,'� �
LOCATION DIRECTION� �d'�'� � `� SY�=1 �-f L� j-�1 L1� �-f�1�.� O� SOt�'f 1-�-
S`'�G '�C7
MULTI-FLO DEALER 5�1��'�rn-��.5 cJA-s"4'� w�!-"t'�-PHONE �► �� � - uq� —�S��
ADORESS: Street � � 1 k'���� '� �--A • �'�
City � �`'11C-6-1'l4'�L - State 1'� ?—) Zip _�5�3'� l„
APPROVING HEALTH DEPT. L1'f� B'� �=���
AD�RESS: Street "�' p '�SD�I- Lp �
City G1�`'t S�CfPr�— ���`�' State rY) Zip ��S.�i�^S
SITE DATE ✓
TEFRAIN: HILLY FLAT LOW
TYPE OF DISCHARGE: SURFACE DIRECT INTO
SPRAY IRRIGATION RETAINED ON SITE
SUBSURFACE ✓ NO. FT. FIELO LINES ►'n���O
FACILITY DATA
NO. BEDROOMS � NO. FUIL BATHS � NO. HALF BATHS
DISHWASHER I� GARB GE OISPOSAL � WATER SOFTENE_�
ESTIMATED FLOW PER DAY
OTHER DETAILS AND INFORMATION:
ELEVATION EFFLUENT pISCHARGE LAYOUT-AERIAL VIEW
(Show lxation of Facility and Uyout ol Plant Inatallation)
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tMOUSE / s��"�'1 �-►oil��
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Waste Treatment Systems, Inc. 2324 E. River Road. Dayton, Ohio 45439(513)293-1100 � 0 M o 0 4- 7 8 6
' , Aulhorized Dislributor For
Schirmers Wastewater Treatment Systems; Inc. ��/j .�► �[� ;j���Q
� 951 ICarydid�I:ane NE•SG Michael,MN 5537G • (G12) 497-35GG � � tAERi4T14N. EQIIIPMENT
� ;SALES & SERVICE
� �GENERAL INFORMATION
OWNEA ��.��� �v�"'��� RESIDENT
ADDRESS �fS) `�'�1S.�V �11•�� ��O ffJ��E9'!�'�L� COUNTY �-�'�`�'� •
DNTE OF INSPECTION ) ��' �` "�� P�O�E 4`7�'"'��3a
UNIT INFORMATION '
T/1NKN0. � TYPEOFTANK ���'� NO.OFMOTORS � SERNUMBER �
CHECK LIST 2 O O O
Tsk� Mixod lle�uor s�npL, ' 3 O O• O ' O �
��
G+�e k A�ar+� Sys t.�ro �� O O$ $� O
Turn Of t I'o►Nr O ,� I �• O
Rtn�e Surqo Bovl O 9
In��c! Ef/luen! Qu11ty �_ 5 � /Q` � �
V�c�n� �Mtr ��+d F�1l�rs C� � O � O
Nesh illters ���� .
Inapxt/Rtplac� Top Cask�t �
i�apoet/Rnplecv Botlo�'" / O O O O � s
lns�»et �l�r+s S�nsors Q
Inepoct Aer�tor • O O O
Turn f`wor On �
CURRCCTIONS RLCOMMCNUCD: REPLACEO FILTERS a
�,� ., . � REPLACE EXPANDERS a ,
COMMENTS
' TESTING INFORMATION '� �
IN FIELD TESTS 'TESTS IN LApORATORY
PH TEMP_ ' B.O.D.
� D.O. D.O. •
C.0.0,_ ' FECAL.COIIFORMS
SFTTi.EABLG SOLIDS 96'�► " eh SUSPENDED SOLIDS
� � /
� .� • UCENSE NUMBER ��' � .
SIONATURE OF SERVICE OR REPAIRMAN �
• � WHITE�He�lth D�p� YELlOW/81111np FU�, . �PINK/M�Inl���nc• .
' Authorized Dislributor For
� Schirmers Wastewater Treatment S .stems; Inc. ;- .� � . �
y M. .1�L1'l. �FLD
� 951 ICarydid Y.au�e NE• Sc. Michael�MN 55376 � (612)497-35GG � ��i AERi4Tl.,ON EQUIPMENT
� ;SALES & SERVICE
� �GENERAL INFORMATION
OWNER �� s MA'�`� �u� �-�� RESIDENT
ADDRESS '► S 1 �'4��al�b 1-1 i LL ��7 � b-�o L1 o COUNTY �"'�•"- � '
DATE OF INSPECTION L `� � -9� PHONE �� V "'>> 3�
UNIT INFORMATION '
TANK N0. � TYPE OFTANK � � - NO.OF MOTORS � SER NUMBER �
CHECK LIST
�" ' � . UO O � �
i�k� Mlxod Ltquor san�pl• .i��� �_ O O' O O
CMek Aa�►n� Systom __ O O � O
turn Of� Pa+er O � ( • O
Ri�se Sur90 Bovt 9 B
Inn�ct Efftuent Q�a11ty � 'L�� „Z O� /Q\ O O
Vaeuwn Fhe1r ard F1�lt�n _ O ^ O
Hesh F11lers ��
ie+�pxt/Replsce Top G�sk�t � �
Jn��+act/Rnplsce Botf.a� " � OO O O O
�
1�ap�et �ls� S�nsors O
Inspoct Aerator • � _�_ . O O O
Turn 1'oMor On �
CURRCCTIONS RLCOMMCNUCD: REPlACEO FILTERS q
�`�m� .�'�'�� �`r'�� �� REPIACE EXPANDERS a ,
^ COMMENTS
' TESTING INFORMATION �� �
IN FIELD TESTS �TESTS IN LA�ORA70RY
PH TEMP_ ' B.O.D.
� 0.0. D.O. •
C.O.D._ ' FECAL COUFORMS
SFTTi.CABLL� SOL,IDS 96 3� SUSPENDED SOIIDS
��� �o�- `—�" UCENSE NUMBER ����
SIONATURE OF SERVICE OR REPAIRMAN �
• WHITEiHe�lth�epl. YELlOWi811tlnq FII�, . P�NK/M�IM�n��c� .
Authorized Distributor For
� ��rmers Wastewater Treatment Systems, Inc. MULTI�FLD
951 Katydid Lane NE • St. Michael, MN 55376 • (612) 497-3566 �AERATION EQU/PMENT
SALES & SERVICE
GENERAL INFORMATION
OWNER �1���'�f ���4 RESIDENT
ADORESS ��� �ti� �1LV �� • �'��d COUNTY 1-��� �
D/1TE OF INSPECTION �� ��'"�� PHONE �7 L -�t 3a
UNIT INFORMATION '
TANKNO. TYPEOFTANK L�J NO.OFMOTORS � SER.NUMBER 6► z1 � �'I
CHECK LIST U OO 1O O
Item Dons Per. Soeca. Need Attns
1�ka Mlxnd 11quor sample _�,�L�.����,,,� OO O O �O �
CF,eek Alarn+ Systen� 3
Turn orr ro�►- OO I OO
a,,,,e s�„�e ea.� �.� O 9 A O B O
Int�ct Effluent Quality � 5 / \ O
Vecuum 4k!1 r•and F 1•)ters O 10 � 1� O
Nash ftlters � 6
inspoct/Replace Top Gasket 1 O 8 9 ��
Tna�xrc!/Rnplece 8ottom " �✓ O 2 O O O
1nspect ster,n Sensora
inspcc:t llerator • O O O O
Turn PoMer On
CURRrCT10NS RLCOMMCNUCD: REPLACEO FILTERS!!
REPLACE EXPANDERS �
- COMMENTS
TESTING INFORMATION
IN FIELD TESTS TESTS IN LABORATORY
PH TEMP_ B.O.D.
D.O. D.O.
C.O.D. __ FECAL COIIFORMS
SFTT[,C/18LC SOLIDS 96�_ SUSPENDED SOLIDS
_„�e��"'"� � �J�--�-�' LICENSE NUMBER 3 �I,'
SI(3NAtURE OF.SERVICE OR REPAIRMAN �
WHITE�Heslth pept. YEILOWi9llling Flle PINK/Maintenence
Authorized Distributor For
- �S�hirmers Wastewater Treatment Systems, Inc. MUL►�'/��LQ '
951 Katydid Lane NE• St. Michael, MN 55376 • (612) 497-3566 �AERATION EQUIPMENT
�SALES & SERVICE
GENERAL INFORMATION
OWNER �-.O 1 S � YY)1L�'¢`� "'C7 La�•\\,.�Ar4 RESiDENT
ADDRESS �S� 5'4�'P�1'�!1 � �-11 Ll.. 'Q-Q . ���10 COUNTY
D/1TE OF INSPECtION _I �� � a 2 � '� � PHONE �? �'' � �3 d
UNIT INFORMATION '
TANK NO. TYPEOF TANK �0 � NO.OF MOTORS � SER NUMBER�D .�I ��
CHECK LIST U OO OO O
tcd+� aa,e �e� . t�eea cc�
T�ke Mlxad L1quor sample '�j� OO O, O �O J
Ci+eek Alarm System 8 $
?urn Of f Po++er OO I OO
R1n�e Surqe ea+i O 9 A B 5
1n��et Eifluent a�a11ly � 5
vaeuWn We1r and f wlters _ O 10 �O� 1�
N�sh F 11 ters --� Cj O
Inaprct/Replace Top 6asket �
in��x!ct/Rnplece Bottan " �✓ O O O O �O s
In+peet alerm Sensors � .�
tnspec:! Aerator • O O O O
Turn Po�+er On �
CURRrCT10NS RL•COMMCNUCD: REPLACED FILTERS p
REPIACE EXPANDERS a
COMMENTS
� TESTING INFORMATION
IN FIELD TEST3 TESTS IN LA80RATORY
PH TEMP_ B.0.0.
0.0. D.O.
C.O.O. __ FECAI COUFORMS
SETT[.CABLC SOLtDS 96� SUSPENDED SOLIDS
`�`�— V �- � � •
LICENSE NUMBER �� �
Si(3NATUFiE OF.SERVICE OR REPAIRMAN
WHITEiHeetth Dept. YEIIOW/Blllln9 Flts PtNKiMalMensncs
� '� Authori2ed Distributor For
Schirmers Wastewater Treatment Systems, Inc. /HULTI�FL U
�51 Katydid Lane NE• St. Michael, MN 55376 • (612) 497-3566 AERATION EQUIPMENT
SALES & SERVlCE
� GENERAL INFORMATION
OWNER �-�L S 1r1'}� "gk..�,'�-('t..)A�`�c" RESIDENT
AODRESS �I�.� ��� �1��- "�"� �''��� COUNTY I��'�� •
D/1TE OF INSPECTION (`�)' 3 �C9 C� �HONE �� �—� 1:�r�
UNIT INFORMATION '
7/1NK NO. TYPE OF TANK � NO.OF MOTORS SER.NUMBER
CHECK LIST � O O O
ILem Per. s Need Attn:
T�ke Mlxtd 11e�uor sample O O O O �
CI+eCk Atar+n System 4 O /` 4
Turn Off Power O J O
Rtnae Surqe Bo.rl O /� I � O
In��ct f_ffluent Quality ���„ O 5
vacuum Fh!1r and Ft•ltars 1� /O\ 10 O
Nash F i 1 ters •�-- O C O
fnaprc!/Replace Top Gasket
Ins�x!ct/Rnpince eottan " � O O 8 9 �Q
Inspec! eler+n Sensors �� O O O O
fnspec� Aerator • O O O
lurn Power On
CURRCCTIONS RLCOMMENUCD: REPLACED FILTERS!t
REPLACE EXPANDERS q
' COMMENTS
� TESTING INFORMATION
IN FiELD TESTS TESTS IN LABORATORY
PH TEMP_ B.O.D.
D.O. D.O.
C.O.D. __ FECAL COLIFORMS
SE.TTI.CABLE SOLiDS 96�_ SUSPENDED SOLIDS
,�� �
�—�" ` � LICENSE NUMBER - ����
SIGNAtURE OF SERVICE OR REPAIRMAN
WHITE/Heatth Oept. YEIlOWiBflling File PINK/Maintenance
{ ` • Authori2ed Distributor For
Schirmers Wastewater Treatment Systems, Inc. MUITI�Fl�
951 ICatydid Lane NE • St. Michael, MN 55376 • (612) 497-3566 AERAT/ON EQUlPMENT
SALES & SERVlCE
� GENERAL INFORMATION
OWNER —L� F 5 M��"4 't7sJ'9�►L�?' RESIDENT
ADDRESS –��� S�`i��al.�1� �1 L� '2sc� ETTLt9 t�.+�t� COUNTY��`� �
DAT E OF INSPECtION - � o�'�— 1� — C�C7 PHO�E ����1 ��',��
UNIT INFORMATION '
T/1NKNO. TYPEOFTANK Ln� NO.OFMOTORS SER.NUMBER
CNECK LIST 2 O O 2
c�+, o«,e � so� ►�a �cc�:
T�k e M l x t a d L 1qv or s a mp le �,�L��}� O OO O O 3 ,
Cheek Alarm System O �0.. '.
Turn Of f Po++er
R1nae Surqc Bo�+l 4 O A I O� ..
I n� /Ii O � O
�ct Fffluent Q��ality � �;t� Q5 10 / 10 5
Vaa�vm Welr ard F1•lters O �\ OO
Nash filters
Inspr.c!/Replace Top Gaske! �
intpr.ct/Raplece Bottan " � O
Inspeet a1e.�n Sensors � �✓ O 7 O O 10 O
Inspect 11erator • �/ O O O O
?urn Power On V�r
CURRfCT10NS RGCOMMENUCD: REPLACED FILTERS q
. REPLACE EXPANDERS#
' � COMMENTS
� TESTING INFORMATION
IN FIELD TESTS TESTS IN LABORATORY
PH TEMP_ B.O.D.
O.O. D.O.
C.O.D. __ FECAL COUFORMS
SETTI.CABLE SOL�DS 96 �=_ SUSPENDED SOLIDS
���� ' LICENSE NUMBER '
" SIQNA7URE OF SERVICE OR REPAIRMAN
�^ WHITE/Heellh Dept. YELLOWiBtlltng Flle PINKiMaintenance �
� � Authorfzed Distributor For
Schirmers Wastewater Treatment Systems, Inc. ���!���f`l�
951 Katydid Lane � � St. IUlichael, IV1N 55376 • (763) 497-3566 �AERATION EQU/PMENT
FAX (763) 497-so�� SALES & SERVICE
GENERAL INFORMATION -
OWNER �► S �G�V �ulllCtl� RESIDENT
ADDRESS ��1 �Dif i f1�l �►�) !� . �ft9ht3 C �1a TY ���
D/1TE OF IN PECTION "' " � pHONE�'�'��� � ( 3�
S
UNIT INFORMATION � '
7ANK NO. � TYPE OF TANK t � NO.OF MOTORS } SER.NUMBER �` /�
CHECK LIST 2 OO �O 2
I Per S Need AtLn:
1�ke Mixad llquor sample C n � OO O O O J
CheCk Alarm System � O ($�
Turn Off Power � OO I OO
R 1 n�e Su►ge Bo�+l _!, � O A O B 5
Ins�ect Fffluent Quallty � 5
Vacvum Wcsir and Fi•lters � O�� ��� 10 O
Nash Filters .r
Inspact/Replace Top Gasket
i�,�t,a,.p,r� e�tti� � � O�7 O O ,0 6
lnspect alerm Sensors 2
Inspet:E Aerator • O O O O
Turn 1'ower On
CURRrCTIONS RLCOMMCNUCD: REPLACED FILTERS!t
REPLACE EXPANDERS�
- COMMENTS
� TESTING INFORMATION .
IN FIELD TEST3 TESTS IN LABORATORY � .
PH TEMP_ B.O.D.
D.O. D.O.
C.O.D. __ FECAL COLIFORMS
SE:TTI.CABLC SOLIDS 96_�_ SUSPENDED SOLIDS
;�� ��. � �e.._.�.
LICENSE NUMBER 3`�J�
SI�NATURE OF SERVICE OR REPAIRMAN
;
WHITE/Health Dept. YELLOW/BIIIing Flle PINK/Melntenancs
f � AUUIOFIZBa UISLfIDI.FIVf 1"u�
Schirmers Wastewater Treatment Systems, Ihc. � �':� :� .,���/ej�
� . ._. _ .. . _ ..
951 Ka#ydid �ane����.1�ic�iae�, N(�V������� j���4��- 56.6� � ;AERATION EQU/PMENT
, FAX(7'63)497-so�� :�,q�ES & SERVICE
�GENERAL INFORMATION -
OWNER ��`��`' ��'�'�� �L"Z�"�'�'�— RESIDENT
ADDRESS ��� ��>>'t'V ���� " ����� COU TY -�
. H�NE�'V' �I�Q
D/1TE OF INSPECTION ��`1� � �
UNIT INFORMATION � ' '
.
T/1NKN0. TYPEOFTANK�B�— NO.OFMOTORS SER.NUMBER —
� . CHECK LIST . 2 �� . � � O
T�.ke M1xAd Llquor sampls '��,�, 3 OO O � O ,
CheCk Alar+n Systain �,� ���� O O O 4
Turn O f f Powe r O O I O O
R4n.re su r po Bowt ' 5 A B 5
Ins�sct Effluent Q►�a11ty �� �,� O� /Q\ Q O
Vacuum Wair and F�lt�rs � O � O
Nash F11tero -�""
Insp�ct/Replace Top �iask�t ,�___
in�pc�ct/Rnplscs BoEtan " _� _„__ . OO O O � s '
Inspvc t a iarm S�n s o r s ��,� . � 3 a O O
Inspec! Aerstor • �,_ �_ • O O
Turn f'o�r On • '
�C:URRCCTIONS RCCOMMENUCD: � REPLACED FN.TERS# �
��� 1� ���`�+�� td��'��1' REPLACE EXPANDERS� ,
• � COMMENTS
' � TESTINa INF�RMATION •
IN FIELD TE8T3 TEST811�t LAB.ORATOAY • .
PH TEMP_ � B.O.O.
0.0. � D.O.
C.O.O._ ,. FECAL COIIFORMS
SFTTt.CABL�C SOLiQS 96,�_ SWSPENDED SOLIE�S
�7�—�---� �. � UCENSE NUMBER '�� �
SIC3NATURE�OF.SERVICE OR REPAIRMAN .
� WHITE/Heelth Oept YEILOW/81111n9 Flls � PINK/MaMt�n�nc� .
„� Authorized Distributor For
S c�irmers Wastewater Treatment Systems, Inc. ���►�'/��L�
951 Ka'tydid Lane NE • St. fNlichael, MN 55376 • (763) 497-3566 �AERATION EQUIPMENT
FAX (763) 497-so�� .SALES & SERVICE
GENERAL INFORMATION -
OWNER � L S �� �1,�►�.� RESIDENT
ADDRESS ��� ��a.��.: �11�.''��. �l9�C L7 �0 TY �-�'�7�'
�ATE �F INSrECTI�N
�A �� —a'Z�- pt�bNE ��l.�l� �t�
UNIT INFORMATION '
TANKNO. l TYPEOFTANK 'Q NO.OFMOTORS / SER.NUMBERS(�L�
CHECK LIST U OO 1U O
ltem Dons Per. S s Need Attns
T�ke Mlxt!d 11q�or samp1A OO O O �O �
CheCk Alarm Systan
Turn Off PoMer OO I OO
ai,,,e s�„�4 e�� Q 9 A O B 5
lns�eci Effiuent Quality 5
Vacvvm WEs1r and F1•lters ,�,f ���r r� �� � � 10 O
Nash F 11 ters � i��/N"1 p�fiT O C O
lnspr.ct/Replace Top GasNet / O O 8 g 10
ins�xrct/Rrtpl�ce Bottan �✓ O O O O
Inspec! alarm Sensors
Inspec;t /lerator • O O O
Turn I'a+er On
CUC2RfCTlONS 1tECOMMCNUED: REPLACED FILTERS t!
� ,� � REPLACE EXPANDERS� .
,
� COMMENTS
� TESTING INFORMATION .
IN FIELD TESTS TE3TS IN LA80RATORY
PH TEMP_ B.O.D.
D.O. D.O.
C.O.O. _._ �, FECAL COLIFORMS
SETTi.LABI.0 SOLfDS 96 � S� SUSPENDED SOLIDS
rn�
� F� �
i�`'l. -��..�.�""'""”' LICENSE NUMBER ��''�
SIGNAtURE OF SERVICE OR REPAIRMAN
WHITE/Health Dept. YEILOW/BIIIing Flle PtNK/Maintenanca
,� Authorized Distributor For
5'chirrners Wastewater Treatment Systems, Inc. �������`l�
... . _._.. ........___.__
951 Katydid Lane N� •�St: IVl`ic�ae�, I�N 5�3"16 • (763}497-3566 AERATION EQUIPh�IENT
FAX(763) 497-so��� .SALES & SERVICE
�GENERAL INFORMATION -
OWNER � ��� 5 M-�►�,� Q �A f1 I u'�7 RESiDENT
ADDRESS q� , �fl�i [1c�. ����� ;r . O�C�t1� _— COUNTY N�n
D�TE OF INSPECTION �',"' ./ `� � � P�O�E 4�6 ' ��3�
UNIT INFORMATION � '
T/1NKN0. � TYPEOFTANK �"� NO.OFMOTORS � SER.NUMBER a���
CHECK LIST � O � O O
i c� f s r+�e c�, .
?ake M1x�d ltquor semple (1 O O O O ,
CF+eek Alar+n Systarn O O � O
Turn Off Pa+er
R1n�e Surya Bowt O A I B O
In�pect Effluent Quality � 5 O
Vseuum 4feir and F1•lters O 10 �O^� �
Nash F 11 ter� �" �,/ O
fnspr,et/Replace Top Gasket
Jn�peet/RnPlsce 8ottan " � • O O O O � .
Inapect a1enn Sensors Q s
Inspcce �erator . O 4 � O
Turn Power On O
CORRCCTiONS RCCOMMCNUCD: REPLACED FILTERS p
� REPLACE EXPANDERS�
COMMENTS
' � TESTINQ INFORMATION � �
IN F1ELD TESTS TEST8 IN LABORATORY � .
PH TEMP_ B.O.D.
�.0. D.O.
C.O.D._ �/'� , FECAL COLIFORMS
SF:TTi.CABLC SOLiDS 96 �7 SUSPENDED SOLIDS
r ��� � UCENSE NUMBER ��
S�
SIDNATURE OF SERVICE OR REPAIRMAN .
WHITE/Heallh�ept. YELIOW/Bllling Flte PINK/Ma�Menencs
� . ... Authorized Distributor For
S chirmers Wastewater Treatment Systems, Inc. �y�LTI�Fl o
951 Katydid Lane NE • St. Michael, MN 55376 • (612) 497-3566 AERATION ECJUIPMENT
SALES & SERVICE
� GENERAL INFORMATION
OWNER �►dI 5 M�7 �1-��R LIOt� RESIDENT
ADDRESS - � S � �1'�� �I 1 L�... �P� � C���O,�-C� COUNTY � �
DATE OF INSPECTION ' � `��VD I ��O�E���"�� �L�
UNIT INFORMATION '
T/1NK NO. TYPE OF TANK NO.OF MOTORS SER.NUMBER �� .� I�1�
CHECK LIST 2 O O 2
t ca+, �� s n�d Acct,:
T�ke Mlx�d L1q�or sample r��� ' 3 �O O O 3 �
Cheek A l ar++► Sysivn OO /�O•. `•
v
Tvrn O�f Power 4 O I O 4
Rinae 5urge Bor+l � � O 9 /� p 5 .
� f'1 �
1ns�ct Fffluent Q�iallty � 10 /
Veeuvm Wea i r and F 1�l ters O O\ 10
Nash Filters C O
Inspact/Replece Top Gasket � �
Ina�ct/Rrtplece Bottdn " �� OO O O 10 s
lnapecC slann Sensora �.
Inspect /leretor • O O O O
Turn I'oMcr On
CURRfCTIONS RL•COMMENUL•D: REPIACED FILTERS�
. REPLACE EXPANDERS!!
' COMMENTS
� TESTING INFORMATION
IN FIELD TEST3 TE3TS IN LABORATORY
i�H TEMP_ B.O.D.
D.O. D.O.
C.O.O. __ FECAL COL�FORMS
SETTI,C/1BLC SOL(DS 96 I�_ SUSPENDED SOLIDS
� � ' � -
'` � LICENSE NUMBER ��,
SIGNATURE OF SERVICE OR REPAIRMAN
WHITE�Heelth Dept. YELLOWiBilling File PINKiMaintenence
, , •�
Authorized Distributor For
Schirmers Wastewater Treatment Systems, Inc. ���T�,,FLD
951 Karydid Lane NE• St. Michael, MN 55376 • (612) 497-3566 AERATlON EQUIPMENT
� � SALES & SERVICE
GENERAL INFORMATION
OWNER Lo , � ���:�C��/ �i,�:�1 I cx,�_ RESIDENT
ADDRESS �K � :��:i�.t f, �� �'°�� i � � . . V r��� COU�TY.ri C�C�
D/1TE OF INSPECTION ,� "" 1 "'� PHONE g��'� � ( ��
UNIT INFORMATION '
TI1NK NO. `� TYPEOF TANK �-��«y NO.OF MOTORS ; SER.NUMBER G� ����`'F
CHECK LIST 2 1O 1O 2
Ikern Per. S Need Attn: �)
?rke Mtxtd L1q�or samplR � ~" ";„,'y,if', ' O " O O �
CM!ek Alarm System O (p1O
v
Turn Off Pa+er OO I OO
R1n�e Surqc Ba+l 9 /\ p
5 r' o
1ns�ct Effluent Quality ��{` 6 jQ �0� 10 O
Vaaium We i r and F 1•1 ters O � O
Wash F11ters
lnspr.ct/Replace Top 6askeC �
��.��,R�p,�� �tt� „ - DOo � 9 ,o
lnspect aler+n Sensors �✓ O O s
Inspec:t Aerator • O 4 O O
Turn I'a+cr On O
CURRECTIONS 1tECOMMENUCD: REPIACED FILTERS�
�A�`� REPLACE EXPANDERS�
' COMMENTS
� TESTING INFORMATION
IN FIELD TESTS TE3TS IN LABORATORY
PH TEMP_ B.O.D.
D.O. D.O.
C.O.D. __ FECAL COIIFORMS
SETTi;CABLE SOLiDS 96__y�Q__ SUSPENOED SOLIDS
i/���� 9 � . /
LICENSE NUMBER � �S
SI(3NATURE OF SERVICE OR REPAIRMAN
WHITEiHeatth Dept. YEILOW�Biil(ng File PINK/Mafntenence
� _ ., � Author•ized Distributor For
�► . , �
�ehirrxxers �astcwa�er Treatment S tems, �Ix�c.
�����
��.;1171rc.�iae1���• ������• :AERA77�N EQUlP1NENT
9�� �d�d��e�� FAX(?63)497-501'� :$ALES & SERVICE
. - . , .
� � � •QENERAL INFORMATfON '
OWN�R t�� I�' �'''^^ ��tn�°`� � - RESIOENT . , �
q fJ 1 �JP(��ti �•� �� ' �(�n c�� COUNTY_.
AooR�ss -��3 -w -
DATE OF INSPECTION . G' � � v4"' a - P H O N E
. �
UNIT INFORMATION • '
�_ TYPEOFTANK C`�� NO.OFMOTOR3 � SERNUMBER
T/1NK NO..._— .
. . .� �CI3�CI� LIST . 2..�• Q Q
3 0O Q • O >
Trk� Htxnd l.lquor saTp.l• ' �.�--� OO O
cr►4ck na.� syre,� .__.- —=--- 4
Turn Off Po�r OO n ' R O
R1nr� Surpo Bow1 O ^ �+ O
Ina�ecb E�f1wM! Quai/ty � _ �.�-- �� / � �O
Va�n Nsir u+d F�lun . C
� Nrsh F i 1l�n '�' .
In,p�ct/R�P1� Top G�sk�! �_ �•— , OO`O O � 6 .
instpact/RnP1�o� 8ottoa� " .�,— ---,--- O
Insp�at �i�rtn S�mers �,.�-.� -.�-=--• ' 4 ��O �$
Inspeat Air�tor � �..��. �--- . . ,
?urn 1'o�+or On • .
CORRL•CTIONS RLC�M U D: � � REPLACED FH.TER8#
�.. T •�„ ���.,,,� �0 �\� na REpLqCE EXPANDERS� ,
� . .
. COMMENT8
' � TESTINQ INF�ORMATION •
kN FIELD TE8T8 TE8T81[�l LAHORATO.�Y • .
PH � TEMP_ _ ' 8.0.0._ .
0.0. • • D.O._
C.O.O._ � � . FECAL COUFORMS
SE:TTt.�a+1BI.'L SOLIQ3 96�_ SWSPENDED SOUf33 �
f
y� � t �j- '� UCENSE NUMBER 3�� . —
SIpNATURE•OF�ERVICE OR REPAIRMAN •
' WHITE/Heetlh Oept YELLOW�81tllnp Rq� � PtNKiMalnt�nana�
. � ` ��ehirrxrers �1'astcvv�a�cr Treatmcnt`.� ,s�ems, �I�c. � .` � � ,F.�,�"����
951 Ka�tydCd'�Ca�te��3'�:;1171fc�iae�� �N(�T�:� �f'���' ' :AERA7'I�N EQUIPMENT
. EAX(?63)49�7-5D14 :�,qLES & SERVICE
•QENERAL INFORMATION �
OWN�R �'I,�iG�'r'n` ��'t�'h'�`o�iP � � RESIDENT . .
�41�. "�L ' !9'���_ - COUNTY�i�--
AODRESS `�s� �" "'" " ,* 7(�3- N 76
D�TE OF INSPECTION � � ' t�"�N PHONE l�3�
,
UNIT INFORMATION � '
TANKNO. 'TYPEOF'fANK NO.OFMOTOR3 SER.NUMBER L�.�
. . C�3�CI� LIST � 2 . .�f ' � � 1� O
r���,��� 3 �O • Q • O >
Tek� Mlxod Llquor sampl� ���5G1aic� ----- OO /�1
(�,edk Aaarm Sy�l�n� .�.— -�---- v l;
Turn orr �.r OQ e R OO
R t nt+o surpa eoal � � .�,�_ O ^ r O
Inapect Effluenb Qiialily !�G`%..�� ----- �� /^� QQ O
Vacuum W�eir and F1�it.�rs � • - V
� Fl�sh F1lters � .
InApxt/R�plaa Top Gask�t �� ....�� •
In�P�t/Rnplic� 8ottan " .�-- --�----- QO O .O �O
Inspoet als►+n 3�nwn �..�.�, �--�-� • � � O O
Inspeat Mra'tor • • �,j` ...�.�. �—�--- , .
Turn Ibwor On �� •
CORRLCTIONS RLCbMMENULrD: � REPLACED FKTER3�
. , REPLACE EXPANDERS# ,
. COMMENTS
' � TESTINa INFORMATION �
kN F.IELD TE8T8 . �TE8T8 I�L LA80RATOAY • .
F�H TEMP_ � B.0.0. •
0.0. . �.0.
C,O.D._ • „ FECAL CDUFORMS
SFTTL.E�ABL'L SOLIQS 96 t� SWSPENDED SOUE�3 �
�� 1 R . ���
� UCENSE NUMBE .
SIDNATURE•OF�ERVICE OR REPAIRMAN •
' WHRE/Halth Oept. YELLOW�BIIMp FU� � PINK/Malnl�n�no�
Authorized Distributor For
S ehirmers Wastewater Treatment Systems, Inc. ; � ;�,�.�/,Fl p
951 Katydid Lane�f�% 5t.�Michae�, 11I�N�5537'e • (763)4�7-3566 �AERATION EQUIPMENT
FAX (763) 497-5,0�� .SALES & SERVICE
,
GENERAL INFORMATION -
OWNER �^ �. I.i ��a�+l.�'� RESIDENT �
ADDRESS ��� ��(��..� `a',II �,C�'1 t`�(`t��,� CO��INTY �,�`���``
DATE OF INSPECTION ` � � �� �� PHONELI��` 113�
UNIT INFORMATION � '
T/1NK NO. TYPEOFTANK�� NO.OF MOTORS � SER.NUMBER ���L
� CHECK LIST O O O O
Item P r tn .
Trke Mixnd Liquor samp le a+r+� E�o.M M.�./ O O O O �
CM�e k A i sr+n Sys tem __ O O ' � O
Jurn orr ro,.e►-
Rinae Surqc eo.�l 9
ins�!ct Fffiuent Quallty �
OO � � O O
Vaa►vm Ne11r and F1•lter� O 10 /�� 10 O
Hash Filtera —►
]nspcct/Replace Top GasNet / O O $ 9 10
Inspect/Rr.pirce Bottan � / O O O O
lnspect alerm Sensors ✓
1�spec:t /lerator • O O O
Turn t'a+er On �
CURRECTIONS RLCOMMCNUCD: REPLACED FILTERS�
i����. an aa�'2. ���H� REPLACE EXPANDERS�
�`",r3�� �_ ,oc�,• � COMMENTS
r.
� TESTING INFORMATION �
IN FIELD TEST3 TESTS IN�LAB.ORATORY � .
PH TEMP_ B.O.D.
D.O. U.O.
• C.O,D. _ � , FECAL COUFORMS
SE:TTi.C/1BLC SOLIDS 96 � SUSP�NDED SOLIQS
.�,..,.
� ���
,��.. �� �`r�..,
� t �'` LICENSE NUMBER �" � *�
SIONATURE OF.SEi�VICE OR REPAIRMAN � .
WHITE/Heallh Dept, YEILOWiBllling Flte PtNK/Melntenencs
Authorized Distrfbutor For
Schirmers '�X1'astewater Treatment Systems, I�c. ; �, ;�►��!...�,�:Y�j;i]
951 Katydid Lane��� �f.�(171ichae), IV(iV�����'�6 •�j7���487-3566� � ;AERATl�N EQUIPMENT
FAX ('T63) 497-sb�� :SALES & SERVICE
�GENERAL INFORMATION �
OWNER �'�,�' �^ �`"��°�� RESIDENT .
AODRESS �I�S� '��("`,fe t+. l�+�� '�.°� ' ���'�C'1�5 COUNTY�����"`
DATE OF INSPECTION ' i�`aG�`7� PHONE y�� ✓ ���`�
UNIT INFORMATION � � '
T/1NK NO. '� TYPEOFTANK ��'� NO.OF MOTORS � SER.NUMBER ������`l
� CHECK LIST U � : � O O
I� P � s Need ttn . .
TAke Hlx�d liquor sample ,ow� O O � O 3 >
C1,eCk A•larm Systgn .O �O
Turn Off Power � OO I O O
R1n9e Surqa 80++1 O A B O
t►,4�ti �rf��e►,c a,siicy r��. O i p ��� 1 0 6
Vacuvm Fk�1 r and F 1•1 ters ^ O
HAsh F 11 ters -°'" �r
Inspxt/Rsplace Top Gasket � / O O O 9 10
1n�Fxrct/Rn,plece 8ottom " O O
1nspec! alerm Senaors , �
Inspect herator • O O O O
Turn 1'a+cr On �
CURRrCT10NS RLCOMMENUCD: � REPIACED FILTERS#
�'"'''�` `^ �`�`�`rt� - REPLACE EXPANDERS�
--� . � •
• � COMMENTS
' � TESTING INFORMATION �
I:N F1ELD TESTS TESTS IN LAB.ORATO.RY � .
PH TEMP_ B.O.O.
D.O. D.O. --
C.O.O. _ ., FECAL�OIIFORMS
SETTt.CABLC SOLiDS 9b �� SUSPENDED SOLIRS
°��---' c-.� , C-�� UCENSE NUMBER �� �
SIGNATURE�OF SERVICE OR REPAIRMMN .
WHITE/Heellh Dept. YELlOW�81111ng Flla � PINK/Meinlenance
CHIRMERS WASTEWATER TREATMENT SYSTEMS,INC.
� Steven B. Schirmers • 951 Katydid Lane NE • St. Michaei, MN 55376
www.mnmultiflo.com - www.multiflo.com
Cert.No.627 • (763) 497-3566 • FAX (763) 497-5011
State License #395
GENERAL INFORMATION
OWNER_�1.1�.,t.�1�'1M '�1.f1�'►'� RESIDENT
ADDRESS �!�1 '��1l��� N'\1.-L '�'C'J p'�?�,.�c,? COUNTY ��6„��r .
DATE OF INSPECTION C� " a.C� "'G��J PHONE ��. < -� c.?
��z - a�� - ��s'
UNIT INFORMATION
TANK NUMBER I TYPE OF TANK �D C? NO.OF MOTORS_�_SERIAL NO. .a) '1
CHECK LIST
E D NE R. PEC . E S TTN: U � � O
T A K E M I X E D L I Q U O R S A M P L E �Q�]N�� OO O O 8 O �
CHECK AIARM SYSTEM (
T U R N O F F P O W E R O J O
RINSE SURGE BOWL 5 O A I B OO
INSPECT EFFLUENT QUALITY G.1,,^'�"pr�"�" O /O � O O
VACUUM WEIR AND FILTERS O 1O \ O
INSPECT/REPLACE TOP GASKET T_, C BO
INSPECT/REPLACE BOTTOM"
INSPECT ALARM SENSORS OO 1 O
INSPECT AERATOR � OO O O O
TURN ON POWER O O O
CORRECTIONS RECOMMENDED• REPLACED FILTERS
REPLACED EXPANDERS
COMMENTS
TESTING INFORMATION
IN FIELD TESTS TESTS IN LABORATORY
PH TEMP B.O.D.
D.O. D.O.
C.O.D. FECAL COLIFORMS
SETTABLE SOLIDS °/a ���� SUSP�NDED SOLIDS
�= � �'��-� - �
�� LICENSE NUMBER �'J
SIGNATURE OF SERVICE OR REPAIRMAN
AUTHORIZED DISTRIBUTOR FOR - MULTI-FLO -AERATION EQUIPMENT
SALES AND SERVECE
� ' '� ,S'CHI
� RMERS WASTEl��4TER TRE�(TMEIVT�`Y►ST'E1�S,INC:
Steven B. Schirmers • 951 Katydid Lane NE • St. Michael, MN 55376
www.mnmultiflo.com - www.multiflo.com
Cert.No_627 • (763) 497-3566 • FAX (763) 497-5011
State License#395
= C,EN�RAL. INFORIIdIIA►TIO�I "
OWNER (.A.)1�--�) !�'4'✓� ��.1�\.,1�� RESIDENT
ADDRESS �f�f �'Q'�'.1�!� 1a1��,,. � , p�t...a p COUfVTY t�►'�R��r..4 .
DATE OF INSPECTION I " � "L� � PHo►vE_ �j��-,���►��,= �� �p
� ���z..-- �,e� -- 3�s'S
UNIT INFORMATION
TANK NUMBER I TYPE OF TANK (o0c� NO.OF MOTORS I SERIAL NO.��,f 7�
�B-IECK LISY'
�T IUl DONE PE SP EE N- � 1O 1O O
TAKE MIXED LIQUOR SAMPLE ��'f�--ti 2 2
CHECK ALA12M SYSTEM — OO O O �O ' �
TURN OFF POWER -""1___ O O
RINSE SURGE BOWL ---�y---� O � I � O
INSPECT EFFLUENT QUAIITY V C�'fi� 9 9
VACUUM WEIR AND FILTERS ` O O O
WASH FILTERS -"�' O 1� � � 10 6
INSPECT/F2EPLACE TOP GASKET� C O
INSPECT/REPLACE BOTTOM" � / 1 O 8 9 10
I N S P E C T A E R A T O RNSORS � �✓ O O O O O O
.��"'— O O
TURN ON POWER
CORRECTIOIVS RECOIVII�IEND�D• FtEPLACED FILTER�
�.1'�a�` ��P��;����� '��,�L� �����' REPLD�CED EXPAIVD�RS
►..5���°�'"�. �OIIAIIA�NTS
' TESTING INFORMATION
Ilol FIELD TESTS TEST� IN LABOP3�TORY
PH TGM P B.O.D.
D.O. D.O.
C.O.D. FECAL COLIFORMS
SETTAB�E SOLIDS % �t� SUSPENDE��SOLIDS
.
,. .
�; .-
�i������ ����^ +�..:. A:..s�'.,,., .. �
�'` �'� � LICENSE NUMBER ��1.E'...s
SIGNATURE OF SERVICE OR REPAIRMAN
AUTHORIZED DISTRIBUTOR FOR -�IUI_TI-�LO -AERATION EQUIPMENT
I
Se4LE� ,�ND �ERVICIE
� .�1,, . ,� Authorized Distributor For
S chirmers Wastewater Treatment Systems, Inc. � . ;���'�����.
9�1 Kailydic! �.ane1�_����.rVficliae�, IV11��55�7`� • (76�) 4:97-3566 �AERATIOI�I EQUIPMENT
FAX(763) 497-�0��� .SALES & SERVICE
,
GENERAL INFOF�MATION -
OWNER � �.�W �� ���►-AQ RESIDENT �
ADDRESS � � � �`'Q'�'►��L� �� � - �Q��' COUNTY)��1�
D/1TE OF INSPECTION �' '�� � " Q� � PHONE '- �V ' F F 3�
� btiZ - �D�- 3��
UNIT INFORMATION � '
TI1NK NO.—�— TYPE OF TANK ��� NO.OF MOTORS ( SER.NUMBER��a� ��
� CHECK LIST �
Item Per. � tn . � O O O O
?rke M1xrsd L1quor aample '��J OOO � �O J
Clk�Ck Alarm System 8 8
Turn Off Por+er
Rin:+e Surqv Borrl • 9 O
. 4O A I . B. O4
t►,��c Frf��e�t a,siity �'�` O 10 ��� 10 O
Vea�vm Wp,i r snd F 1�1 ters
Ht+sh F i l ters ��L�,{ ��% O �j O
Inspr.ct/Repince Top Gasket •
1n��x!ct/Rrtplace Bottom " � � O ��
lnspect alerm Serisora �� OO O O O
inepecE lleretor • � O O
Tvrn Pa+er On �
CURRCCTIONS ItLCOMMCNUED: � REPLACED FILTERS�!
������ �� !� `�� �� �'��,�`� REPLACE EXPANDERS�#
^ COMMENTS
� TESTING INFORMATION .
IN F1ELD TEST3 TE3TS IN�L.AB.ORATORY � .
PH TEMP_ B.O.D. .
D.O. . D.O.
- C.O.D. _._ , FECAL COUFORMS -
SETTI.C/1$L.E SOLIDS 96'�.1 W�� SUSP�NDED SOLIDS
�E�_,.�. ���� ,� �!..� ��...�:_....�.�..__
%�---� - .`.�,- LICENSE NUMBER �g'�
SI�NATURE OF SERVICE OR REPAIRMAN •
WHITE/Heelth DepL YELLOW/Bitling Flle PINK/Mslntenence
�+ Authorized Distributor For
Sch ri mers Wastewater Treatment Systems, Inc. � �I
. ._ � 95� Katydid�Larie�N� • St.NIicT-iaeT,�IVI(�i5�35�=�y��3)�497-3566 ....����QV�I��
FAX (763) 4g7-501'I . .SALES & SERVICE .
� G�NERA� INFORMATION � �
.
OWNER ��`("��' ' .�._._ RESIDENT
ADDRESS _ ��� S ��nr� I A � (`Z Cl COUNTY�n r�. �
D/1TE OF INSPECTION � ��"�`'����' �P ONE�� +���� .
. �la -�o� - , 7S-�'�
UNIT INFORMATION '
T/1NKN0. ' TYPEOFTANK_ �� . NO.OFMOTORS I SER.NUMBER 6���71
CH�CK LIST
I�`" Do Per. S s. Need Attn: O II O �
T�ke Mlxcd Ltquor sampla � p/� • z
2
c�ek nie� sysE�, _ 3� 8 �. � � O � >
Turn orr r�,- � O 9 0 (� O �
R Inqe Surgn Bcn,1 ✓ O /� I O
lnspect Effluent (h�allty �/ (,,j�,,�,,_. O H O B O
Vaaium Ne1r and Fi�lters y� O 10 /�\ i o
Y 7ash F 11 ters �iY 6 O '
]nspect/Rr.p1ace Top GaskeE �
ln�pc;ct/Rr,place BoEtom " / f
Ins n e e t a l e r m S e n s o r s ��� . �,� oo �o o .10 ,
inspeot Aerator . � O O O O O �
iurn hover On
CUR121�CTIONS RLCOMMCNUCD_ _ REPLACED FILTERS tt
REPLACE EXPANDERS tf �
' � � COMMENTS �
TESTING INFORMATION �
IN FIELD TESTS TESTS IN LABORATORY
. �'E� TEMP._
B.O,D,
. D.O. ' � D.O.
C.O.D.__ ' FECAL COLIFORMS•-
SF.TTLC/1BLC SOLIDS 96 SUSPENDED SOLIDS
. . -------
��.. ��_., �,�.:.�.�... . ._ -- . .
LICENSE NUMBER ��� �
SIGNATURE OF SERVICE OR REPAIRMAN .
' WHITE1Heallh�epl. YELLOW/Billing Flia PINK/Malntenance. �
,�.�.,�.SCHIRMERS WASTEWATER T�EATMENT SYSTEMS,INC.
Steven B. Schirmers • 951 Katydid Lane NE • St. Michael, MN 55376
www.mnmultiflo.com - !, www.muitiflo.com
Cert.No.627 • (763) 497-356�6 • FAX (763) 497-5011
_ State Licens;e#395
GENERAL INFORMATION
,
OWNER�Ja�c�t-� � �I����'�v.c�'� �Mc��e�� i RESIDENT
ADDRESS �1'S ��f`� ���� C�� � �Cs)i�� COUNTY �,t�
DATE OF INSPECTION '�� \"1•''�� PH(�NE'��e�^ �`1�"?(,�•10`�jc� Co�:�•�4�`��IS�
UNIT INFOR�IAATIOId
TANK NUMBER �, TYPE OF TANK �t� I NO.OF MOTORS ,� SERIAL NO. ����N
CHECK LIST I'
ITEM DONE PER.SPECS. NEEDS ATTN:
TAKE MIXED LIQUOR SAMPLE �_ K?'�1 C� �S� �O O O ; >
CHECK ALARM SYSTEM I 8 O U �O
TURN OFF POWER � , O 8
R I N S E S U R G E B O W L � _ O O
WSPECT EFFLUENT QUALITY _y� �` O O n I B O O
VACUUM WEIR AND FILTERS �_ ,,/ ..�,� ���
WASH FILTERS JC ���1 ��j� O 10 /O� 10
r-
INSPECT/REPLACE TOP GASKET �,_ ' Q C 6
INSPECT/REPLACE BOTTOM" �_
INSPECT ALARM SENSORS _� � � OO �$ O 10 OO
INSPECT AERATOR I
TURN ON POWER � I �✓ O OO 4O O
y � , I
CORRECTIONS RECOMMENDED: y �I ftEPLACED FILTERS
� FtEPLACED EXPANDERS
� COMMENTS
MONITORED DRAINFIELD FOR PERFORMANCE'�
�
TESTING INFORMATION
IN FIELD TESTS ' . TE$TS IN LABORATORY
PH TEMP ', B.O.D. � ,
D.O. � D.O. �
C.O.D. " ' FECKL COLIFORMS
SETTABLE SOLIDS %�.1� � � -
_t'�'°i��C..,� SUSPENDED SOLIDS
�i UCENSE NUMBER
SIGNATURE OF SERVICE OR REPAIRMAN ,
AUTHORIZED DISTRIBUTOR FOR - MUiLTI-FIsO -AERATION EQUIPMENT
SALES ANd SERVICE
_y� SCHIRMERS WASTEWATER Z'REATMENT SYSTEMS,INC.
Steven B. Schirmers • 951 Katydid �.ane NE • St. Michael, MN 55376
www.mnmultiflo.com L' www.multiflo.com
Cert.No.627 • (763) 497-3566 • FAX (763) 497-5011
State Licer�se#395
�
CENERAL IN�ORMATION
. ;
OWNER �0 A��-L �r W��..�.-��Qy✓� ���.�„��-� ' RESIDENT_
ADDRESS �'i a) S'�)1°�-1L, N1�.�.. "�F"�. ; U�t?��tJ? COUNTY �='�1,�,,.�,.
DATE OF INSPECTION � l a.-► �- p�; PHI NE q$?,�47�,- 11�A . t,�'?��aq'�,� �lJ,��
UNIT INFOf�MATION
TANK NUMBER TYPE OF TANK t�� II NO.OF MOTO S ,
R �_SERIAL NO. �v, 7�,1�4
CHECK LIST I'
E P _ --
TAKE MIXED LIQUOR SAMPLE � ,,.t, �, O O 2
CHECK ALARM SYSTEM � � 3 U O O O O � �
TURN OFF POWER j'�
RINSE SURGE BOWL �- I O Q v O
INSPECT EFFLUENT QUALITY � _C� ' OO � I B O O
VACUUM WEIR AND FILTERS I 5
WASH FILTERS `�-- 1O
0
INSPECT/REPLACE TOP GASKET ' O 10 /C\ O O
INSPECTlREPLACE BOTTOM" �--�- '
INSPECT ALARM SENSORS Y I ./ OO O O 1Q O
INSPECT AERATOR � �✓ O O
TURN ON POWER �' . OO 4O
CORRECTIONS RECOMM NnF�• REPLACED FILTERS
� REPLACED EXPANDERS
; COMM�NTS
MONITORED DRAINFIELD OR PERFORMANCE
� �
�
TESTING INFORMATION
1N FIELD TESTS . TESTS IN LABORATORY
PM TEMP ' � B.O.D.� -
D.O. D.O. .
C.O.D. � ' � FECAL COLIFORMS
SETTABLE SOLIDS % - SUSPENDED SOLIDS
r
��� ^r R �� {I '� , UCENSE NUMBER ��1�"�
SIGNATURE OF SERVICE OR REPAIRMAN
AUTHORIZED DISTRIBUTOR FOR - MUL�TI-FLO -AERATION EQUIPMENT
SALES AN[� SERVICE �