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r <br />9" <br />12175 County Road 51 <br />Cologne, MN 55322 <br />Andrew Kleindl L2926 <br />www jims excavatinca.com <br />852j-442-9282 <br />�' Property Owner � C%�� l i �' u �Z la's <br />Date, <br />at �_�-- n AA <br />A <br />Address:. <br />Email Address: <br />Service Record <br />Reason: <br />Pump Se-- emergency <br />i� _ <br />Access Used to Remove Sepia Majnt�'nance tial Other <br />Leaking Observed YesJ <br />Disposal Site atertown Treatment FacHi ,Blue Lake <br />Concerns <br />Quantity <br />#Gallons______ <br />v€3c—, .l,tt,ivn <br />pumping/Disposal <br />Repairs -Parts <br />Other <br />Amount <br />� 7, <br />Septic Compliance Inspection <br />Gould'i3urnp Replaced PIE41, € E61 <br />Effluent Filter Cleaned <br />TOTAL <br />Gt'-;V <br />If owner refuses to allow SSTS to be Pumped through the maintenance hate, sign this statement, <br />I _refuse to allow the removal of the solids/liquids through the maintenance hole. <br />Date: <br />owner's Signature: <br />Maintainer Information The work was personally conducted by Andrew Kleiondlunty keeps these Excavating. <br />This report will be filed with your appropriate reporting agency. Typically city <br />records on file. outnwama*2M <br />