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P,RoppC-p Ri CE 7-Y 14 fl <br />JIM EICHE <br />1205 LaBeaux Ave. N.E. - St. MicFiael, MN 55376 <br />U e Phone: (763) 497-2764 • e-mail: duaneseptic@centurylink.net <br />Septic Service, LLC <br />MPCA Lic. # 654 <br />DateT � �(� Statement <br />Pumping Fee: �y� a! Name: LkPL nrlj �✓L. <br />Long Pull Fee: <br />Address - <br />Long A �e'-10WV <br />Other i/. s✓ a %%I_ City/State/Zip",_.L Ac,;pA <br />Total Cost of Se tc -� <br />Septic Tanks & System Condition <br />-------------- <br />----------------OFFICE USE ONLY ----------------------------- <br />Disposal: ❑ Land Application ❑ Wastewater Treatment Plant <br />Disposal Site: Ti_ <br />Gallons: LPIawad: : O Yes ❑ No <br />Time: Temperature: Time: Temperature: <br />