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Report PLM -o19 - 00 .33 Invoice P.O. Box 1260 Date Due Date Invoice# Boring, OR 97009 5/25/2017 5/25/2017 INV-28767 Bill To Job Site Jeff Van Sant 12070 SW Ann St. Jeff Van Sant Tigard, OR. 97223 070 S Ann S 'gar., OR 97223 S.O.No. Terms P.O. No. 23718 Due on receipt Quantity Description Amount 500 Pumping Residential 613 Pumping Residential 325.00 1 Stress Test- Not Applicable 340..41 1 Locate and Uncover Full System 0.00 325.00 Inspection paid for another party. THANK YOU FOR YOUR BUSINESS. Your payment options include cash, check, or credit card. Total $999.41 Please telephone 503-928-6230 to pay by credit card. A finance charge of 1.5% per month will be charged on all past Balance Due $0.00 due invoices. Accounting Office:503.928.6230 Accounting@speedysepticservice.com Office Phone: 503.663.2807 Office Fax: 503.663.9712 www.speedysepticservice.com ,t:,''-.ACT . 0 II',','fill'''')11/11 0 Scheduled 11/14/16 Se t# o�: p C C. ®, ,p a Ritter ■ 4 Date 11/08/16 C ity £ Work Order# wp27 P.O. Box i4432 503-252-61 ,, , Inc� , Po�t�and, OR 97 30087 Salem 503-363-2464 Vancou er 36 Complete Industrial 0 896-5256 Waste Removal Septic Tank Cleaning „p� 4 Sump tineleaning (� RotscMy Incorporated , I 9210is by 62nd Ave lIto�" Vancouver, WA Wa Kington County 98665 0 I it r '. . ..ltvafnut St OR 360-686-3072 97123 Prr II Co L� td b © tact:Hans 'W d C� -`t# - 360-605-5056Hans i 1588-012 • "?V x'�Z t N� �. .j .1,:-.41-,,,,t,,,,,_,,,,,,,,--,--,,;;:v;,- a sire ,a , � � 1 a y, F,(, F ®t, < "' �, 4' n a ,. Notes' Ortlere ,� ,,; 1 . KS K ' ,i' .r�, t ',,,,,,:,„-;--;i-,.:,.::..---:b�Austin Patdo �tact ` ` � i'%'1'.':'.;;.:',,;(-';''-' � � � .� � .� reby ; , onsite con : ' � ew a Y {3 .4',"!-::',11;-,-,` � ' �' Lid will - ."`t `vas ° � t' ,r Tease d//30 minutes .dor ,. � ` n `. K te s `k : t to belt;• . ,- be exposed, /e .,,, onset rt L' i. p ase,pum septicfi , � tank on t - � - i^ ,� .rr � '''.� �'�� :117:11 `,a� ra a '� �te� ,� o�`' � trp ro 7 s� 'f Thank you KLA} k ' 42,H,-''',,,t- .04 , ". ' ,,,,,,-,'„'.- ,k:,2,' � a,,z 1Pv y r ' t,�-�� a �s. fii"*;z ',prs -W � .( C--',.-:::-..-";'-',:'''''';'--'•--,:-! �, � ���`Iaay '� a•re , �' � , l' " x55 r,ti� . .f="-V...,4'` } River Ci ` x `�� City Environmental,Inc.Is in no Total Char.es ' Terms:Net 10 days. o way responsible for damageokan Y 1.5/e peer month will be ,. r..- char Y vehicles, „- gad on i' Personae or realproperty. �-�Y '• Past due accounts(18% � `• . :� The customer agrees@►n1S and C per annum). i to pay all envoi¢�s arisingout of Conditions The” f1 The customer agrees to pay such ogee services,and i, g0 to Lien J schedule,on and overtime chargesany other special services herein within 10 days. behalf of the customer, as may be invoiced customer agreesfrom time to time for services rendered,over and above the normal servicing toassume responsibility � The customer premises, the drivers itadamage to customer's real or • onnis includes,but is setwhereetot driveways, vehicles of River City Environmental,al,Inc.have beesonal property arising of If River C ^`ays,trees, services which take place City Environments,finds it nese power lines or poles and buildingstructures. s�ructed to enter. Customer agrees to reimburse necessary to add liquid to the tank ono i `_ collection or to serverights g River city Environmental for all reasonable alto Customer will be chs If this their ri ht under this agreement for the additional gallon work order is not contested In writing ® ment. attorneys fees.court costs ard other ex gallonage resulting from these g within 10 days the full amount is incurred by said company to enforce didtions. Considered due and payable Customer agrees to the above conditions. Oregon CCB#147355 Washington CC Check# A fax on the work order is considered an�inaRIl. E981 t Visa MC Amex Card# genal: Work Authorized RedeemableDn Multnomah County �� /�p1e, s print) r �.<< Exp Date Signature , h ' . , is Vcode Service Tech#1 v , , Date/j,� � P4, - Service Tech#2 . V tivM ' Date �_/ Time .- ACT- n 31111111111111 ( ., Date 11/08/16 UO UD.C Scheduled 11/14/16 . ....,Nr, , * • Work Order# W0274433 07:00: itiv4JrcityrrOnmeifital Inc 0 '11 503-252-6144 Complete Industrial Waste Removal P.O. Box 30087 Salem 503-363-2464 Vancouver 360-896-5256 Septic Tank Cleaning Portland OR 97294 - K .' - ,,....., Sump Line Cleaning ) --s, , c .... Rotschy Incorporated Washington County 9210 NE 62nd Ave i ////0 SW Walnut St .)6 o'- -. E:‘ 1 ?,..i.,-- .1 Vancouver, WA 98665 t c cA-v ti " b OR 97123 ',„, 'Ti•.! ..--' Co tact:Hans ',- 360-605-5056Hans 360-686-3072 i?L=i41:1t)— ... ,. -• • PL . 614-00 48it lc .. . , , , , , ,,,d,,,,,;,,,'-'''-f';`.:1&,'''''''',!;','".".",-,"".7"";"," ;;,;.'"„t"."',"..'; -:;"="",'''." . . ' ,, ' - , ' " ,' '`.,..'1'. 4k :''..-g...,,,..:.! ,,<!',',..;,...,"'4,',,,..?..61.q10,,,,,A'k,...-%.•.q, l......, 21.1111111111111.mim ' ti41tr eii.k. ' ‘ ii ..',`,:-Ai,',..''',.4,'"'".,.„,'.• .'... ''• i„,,,- . ...,,•„; • , - ., - --, ..,,,,,, '•,..: -,..,:`.%:".e:,..:--'7.,.'? .'":".';',A.:RP,';',10741,Aft,1$4.,`•*: -...r... ... ,m...•,.. ''71',7-';',.:.,•"•";'..'%A-..,',.'•''' '''- `4...,,,, ,", : •-•'', A , " . . ...5.,, f-r.;',,: ..;•,'--7.-',.,:•;.94.,.4.-;:._,-;,,..,?/-,1;4A.4„.,„0,, ,,1,146'.,,..4.,„,„;:1,1.,,A Notes '' -Ordered Austin Pa/do, onsite contact please call route 30 in/n. .rlor to belt,. oilsit,,-4M4t7::: 366,iii;lie ii.,174,',--.4-;14...2';$;.f*firi.,k7:4171i:i'Viic . ..7'...- ,•:':':',. . .,,:..,-.-:i. • ' `•,,,'.,,.'h,--„....-'''''-`.•;.,,,-;•,",-.,,,lzt:.:1,..-I'llk`FP,**41,-.44.,x4k%,,,,,k.‘„,Nt';'. ' ..r4.1.. .-.,,,,...,,e ..-4,:; ,,,,,,,,t,:, ,, ,v. ..,,,_.,..-,.. . -.'...;-....; -, .,,.„:„..•4.:. ( -;,:i''', 1ids will-ii e exposed,ple aS e Pump septic tank on. 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Terms:Net 10 days. 1.5%per month will be charged on past due ac •unts(18%per annum). Terms and Conditions Th,Right to Lien The customer agrees to pay all invoices arising out of services,and any other special services herein thin 10 days. schedule on behalf of the customer. The customer agrees to pay such extra and overtime charges as may be invoiced from time to time fo services rendered,over and above the normal servicing The customer agrees to assume responsibility damage to customers real or personal property arising •m services which take place on customers premises,where the drivers and vehicles of River City Environmentat Inc.have been in tructed to enter. This includes but is not limited to driveway&trees,power lines or poles and building structures If River City Environmental finds it necessary to add liquid to the tank on jobsite,customer will be chs!-.for the additional gallonage resulting from these condidtions. Customer agrees to reimburse River City Environmental for all reasonable attorney's fees court costs, d other expense incurred by said company to enforce collection or,to serve their rights under this agreement If this work order is not contested in writing within 10 days the full amount is considered due and payab s. Oregon CCB#147355 Washington CC:*RIVERCE981BT Customer agrees to the above conditions A fax on the work order Is considered a Original Redeemable in Multnomah County Check#.....___ _____ Visa MC Amex Card# Exp Date..._______ Vcode ........„______ Work Authorized by(please or' t) -,- ..-, ./..') r's -7' •r...7 // /Y Date I/ ,,, ,...- Signature ite," 7k...‹.;"?(.. Service Tech if •SIMIlitrj' Service Tech#2 , /6 • Date/If / / Time .ft Ma- r 7:1 ' ' • ' ,. . ‘. 51;r787e, 503-296-1056 Eit � ;, 21880 S.W. Farmington Road Po BOX lose , I Beaverton, Oregon 97007 Portland.OR 97$10 . '' PHONE: (503)642-2531 _,:,1.:',.::,,,,,,,,, ,.. FAX: (503) 642-2534 27895 RA1ER NOtK / Delivery Receipt Date ` T .. Fmgtn Rock f DATE: 11/15/2018 TICKET NO. Sold To .. I I TIME: 10:35:33AM 310169757 I SOLD TO: Rotschy, Inc. Company Rep 9210 NE 62nd Ave. ti- Vancouver,WA 98665 Job Name \ i^,Jer i k�R i 4 PROJECT: P/P Walnut Ridge 2016 P.O.# SHIP Plant Pickup TO: Conveyor Truck Service SW Walnut St-Tigard ;: Hours ; Hourly Service I t r? ,VIII.in ORDER NO: 69379 ACCT. NO: RO3333 Per-Load Service CUST. P.O. : Loads ZONE: 99 Site One Conveyor Trucks Material Sold DRIVER: 3273.06A 06A Site One Conveyor T Quantity Type i PRODUCT: 91 Sand QTY ORDERED QTY-1 0 DATE QTY TODAY 0.00 19.12 19.12 I GROSS TARE NET 37.41 18.29 19.12 CI S-1 Account TOTAL: IAMOUN L UNI L PRICE TO IAL [ ❑Credit Card Check# 19.12 Ton Job Description: -7 i i I OTHER CHARGES: I ii Ail 1 OPEN ACCOUN I I .NMS: Net 30 days,up to r 92%per CONDITIONS OF THIS SALE ARE LISTED ON BACK PLEASE READ AND UNDERSTAND BEFORE SIGNING! month(eqto 18%per. I annum)teservice f charge lin applied to all past due accounts. In the event of any default in relation t I UNDERSTAND AND AGREE TO THE CONDITIONS LISTED ON this agreement,purchaser(s)agrees to pay all Baker Rock Resources'attorneys'fees and costs including those on appeal THE BACK OF THIS DELIVERY RECEIPT. I AM AN AGENT OF THE COMPANY LISTED ABOVE ON THE''SOLD TO"LINE AND HEREBY even if no action if filled. AUTHORIZE FULL PAYMENT FOR PRODUCTS AND SERVICES LISTED ABOVE.' Customer assumes all responsibility for any damages beyond curb line. A/Izae.„..„... Signature , , i i PLIC Po II,—00 4 Department of Health and Human Services Environmental Health Program `a�,TUlyrp 155 N. First Ave, MS 5,Suite 160 GZ Hillsboro,OR 97124 3 Telephone: 503-846-8722 Fax:503-846-3705 www.co.washington.or.us/hhs/EnvironmentalHealth Pttil>PC h EGO Preveennt.Promote.Protect. SEPTIC TANK DECOMMISSION (ABANDONMENT) - - --- Property Owner Name: (please print) , f Township: Range: Section: -- -- I Tax Lot#: Property Address:(include city,state,2tp) ° r — — _ Was pumped of sludge on: �' ��� ,,L„, Date _ -- �f; Signature of Licensed Operator �/ License#: y t-2( E A"Iri ❑ Was backfilled with sand or dean bank run gravel AFTER beingf_t., .1- — �!— pumped of sludge on: Date: 0 Was connected to city sewer: Date: Signature of Operator: Oregon Administrative Rules 340-071-0185 Decommissioning of Systems 1) The owner must decommission a system when: (a) A sewerage system becomes available and the facility the system serves has been connected to that sewerage system; (b) The source of sewage has been permanently eliminated; (c) The system has been operated in violation of OAR 340-071-0130(13)and a repair permit and Certificate of Satisfactory Completion have not subsequently been issued for the system; (d) The system has been constructed,installed,altered,or repaired without a permit required in this division,and a permit has not subsequently been issued for the system;or (e) The system has been operated or used without a required Certificate of Satisfactory Completion or Authorization Notice and a Certificate of Satisfactory Completion or Authorization Notice has not subsequently been issued for the system, 2) Procedures for Decommissioning: (a) Tanks,cesspools,and seepage pits must be pumped by a licensed sewage disposal service to remove all septage. (b) Tanks,cesspools,and seepage pits must be filled with reject sand,bar run gravel,or other material approved by the agent,or the container must be removed and properly disposed. The septic tank at the address above has been decommissioned in accordance with the Oregon Administrative Rules. Property Owner Signature: �— — • ,, ( . D• ate:I �, -7 08/2016 \ , -- 1 J \//m� [:1111111111111j 1 NOTE: 1 R L. FOR POOL DECK: 0 �� ( ��!� . STORM DRAIN PIPE EIS 4"DIAMETER \ /\ -0----- �I 1 SANITARY PIPE IS 6"DIAMETER a a.:1ex o C G1\ ..... r, b.G '\ . _ _ - \ Q - ®lam o 0 12 ��P�G1 o 1 so. ;#;# G9911ov v w 1 NOTE: °=!1 PSP ' ALL CONNECTIONS NOT G1 1, STRUCTURES TO BE WyE MADE AT I CO P �� 1I-- - ,0°- ‘(? / c l ` I 1 CONNECTIONS W ���! i`.: 0 ,.. NOTE: II . awx — _ }} Q �I BBQ '- ®I 1 FILTER BACKWASH HUB INSIDE J Z — _ MECHANICAL ROOM MUST BE 4" H Ce IX 1- vobw E _ POOL �-° lit %® ,p________, 1 MINIMUM WITH 6"HUB. FLOOR DRAIN w C fl ®'oivx© MECHANICAL ROOM SHALL ALSO Y LL d 0 IIaamw „i CJ 1 TIE INTO SANITARY SEWER. W Z o — �I © l v 1 a cn z - i I II I i 1 III I 1 iI bwh I — -- — 1 I .: I t I II 1 :11 COMMUNITY , I ,1 I 1 I ` -- 1C li BUILDING 1 el 1 LL, I� z INF WALE 1,1o. 111 DEM. I�E nx , 0 If �LL c0 sHEE- OPOOL- --I ITY EXHIBIT '00 ce 02 41Iexin ANALYSIS REPORT nalyt. Professional AidLaboratory LABORATORIES, INC. Services 13035 SW Pacific H . Reported: 05/22/2017 Tigard,OR 97223 Sampled: 05/19/2017 Tel.:(503)639-9311 Fax:(503)684-1588 Received: 05/19/17 Sampled By: Ryan Kruse C C.H. Kruse Plumbing Work Order: 7139025 Paid CC Attn: Ryan Kruse Project: Scholls Ferry Apt. 5802 NE 88th Project#: N/A N Vancouver WA,98665 77 T Phone: (360)518-1375 Sampling Location: 13351 SW Hawks Beard St. B "4 Sample Matrix: Water ?LR a-c)(b - 003g6 Lab Number Sample Name 7139025-01 Lay Faucet Upstairs Unit Microbiological Analysis Sampled: 5/19/17 14:10 _ ---— .-.._Method Result Analysis Date/Time A Total Coliforms SM 9223B(colilert-18)21st Ed. 5 Absent 5/19/17 15:38 A E. Co/i SM 9223B(colilert-18)21st Ed. Absent 5/19/17 15:38 A=All procedures for this analysis are accredited in accordance with NELAP standards. Lab Accreditation No. OR-100013 Approved by: _ e � Steve Williams Microbiology Technical Director This report shall not be reproduced,except in full, without the written approval of the laboratory. Page 1 of 1 P.O. BOX 1050 ' i '. . . _WES1 GASTON,OR 97119 J- �' -0 f1 . ' 503-522-2727 CE# --1 t., --: 1 " 503-687-2381 FAX DATE "22 g • JOB# 1 TECHNICIAN �i. ` < (503) CUSTOMER -� ' .r� #�Yg' " i x ADDR _8�" IV #! 'ar. CITY , ,5222727 .r STATE ZIP ' Z HOME PHONE# } CCE3#202772 CONTACT# "��, , DLI#WESTSSD874BC . FAX# TIME !N YES DAYS______-_•_- ,, .!,'r�"�� DRAIN NEED FLAT/ GUARANTEE NO i�!!� TIME OUT ,��' r:L'nPM SURV. HOURLY AUTH. DRAIN CLEANING guesaiMAINLINE PERFORMED 11.11 HOURLY �r#r'I ( "� prt ADD.DRA4NS�-� all FLAT imilliammG tai .i • -• �, C LAUNDRY LINEe .�i[i r` °fiT FLAT GREASEPUMP BATH SINK FLAT � BATH TUB VIDEO INSPECTION all RM FLATillIll'' - ���� / WATER JETTINiniminien.........41i 11.1111111111111111111111111111.1 G SHOWER � AT � limmem URINAL FLAT TOILET EXCAVATION NMI FLAT �� t1 PRODUCTS FLOOR DRAIN a FLAT .rr NM AREA DRAIN r PARTS HOURLY LABOR EMI RAIN DRAIN ,.. NIIIIIIII I. HOURLY SEPTICMim %��_ DIAGNOSIS FEE "' � LINE LOCATEuIIIMIIIIIIIIIIImLlpr ana ROOF/2ND FLOOR M APPROVAL CODE# SECOND MAN IIIIMIMII PARTS CHECK# QTY. PART# DESCRIPTION PRI11111.11.111111 CE ENZYME TREATMENT RECOMMENDATIONS ' 1111111111111"111111 D. ROOT KILLER a IDEO INSPECTION "�l illria -----.4 .101�,�ANNUAL MAINTENANCE IPE REPAIR/REPLACEMENT TOTAL _•r= O CLEANOUT/INSTALLATION ADDITIONAL TERMS AND CONDITIONS CONTAINED ON i ATER JETTING O PAYMENT RECEIVED l,�9 � ifilalli jfiniriall THE,REVERSE SIDE OF THIS SHEET BALANCE DUE ra,IMIAii PgTSIDEDRAINANDPLUMBING.COM X 'r �/ AC.: 'TANCE OF ESTIMATE AND TERMS AND CONDITIONS ACKNOWLEDGEMENT 6F COMPLETION _-