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Pumping Re <br />Sewer Services Inc. Lic 250 <br />Date Serviced:Driver. <br />: <br />A (-C" <br />Scheduled Maintenance: `': ` Emergency Service., <br />Name: MeAC\1/,Ap <br />in 4 iy <br />Address:' <br />Did you measure the accumulation of scum and sludge? <br />Tank 1 ITank 2 Tank 3 Tank 4 <br />Gallons Billed' <br />Scum �' <br />Sludge <br />full- <br />Operating Depth'` <br />Access used <br />Depth to lid j' • - <br />I refuse to allow the removal of the <br />the maintenance hole. I understand that removal of solids and liquids 1 <br />ois not considered points eyed a compliant method of solids removal and dog <br />removal requirements of Minn. R. 7080.2450 and 7082.0600 <br />L. <br />Owner's Signatu <br />-Type --. P_re.caBlock Concrete <br />2 <br />Plastic - Othe <br />