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INVOICE -Septic Service Record <br />Andrew Kleindl L2926 <br />www.jims-excavating.com <br />(952)-442-9262 <br />Date of Service: �7 <br />Property Owner <br />Address: �f� (7) ��1'1���i.��' /� kJAvzaA i I4 <br />Email Address: <br />Service Record <br />Reason: Ro_ t' e Pump Service Emergency <br />Access Used to Remove Septage. aintenance Hole > Other <br />Leaking Observed Ye <br />Disposal Site Wrtown Treatment Facility , Blue Lake <br />Concerns <br />Other <br />Quantity �� % <br />Description <br />Amount <br />#Gallons #Tank � <br />Pumping/Disposal <br />$ 6 <br />Repairs—Parts <br />e r` <br />Septic Compliance Inspection <br />Gould Pump Replaced PE41 PE51 <br />Effluent Filter Cleaned <br />A Id", <br />Trip- Labor <br />TOTAL <br />If owner refuses to allow SSTS to be pumped through the maintenance hole, sign this statement, <br />I, refuse to allow the removal of the solids/liquids through the maintenance hole. <br />Owner's Signature: <br />Date: <br />Maintainer Information The work was personally conducted by Andrew Kleindl, of Jim's Excavating. <br />This report will be filed with your appropriate reporting agency. Typically city or county keeps these <br />records on file. 11ndjW 7iWn& #2926 <br />