HomeMy WebLinkAboutSeptic Tank Pump Report & ReceiptUnítedUnited Site Services of Colorado, lnc.
Customer Service: 1-800-864-5387
Customer lD:
lnvoice No:
Terms:
P.O. No:
Our Order No:
lnvoice Date:
Page: 2
uss-434988
114-6027527
Due Upon Receipt
0-1227263
11t13117
Biil
To:
JOHN KNIGHT
20 cR 316
stLT, co 81652
SITE $ER.VICES
INVOICE
Ship
To:
JOHN KNIGHT
20 cR 316
stLT, co 81652
Total:498.30
Please detach this coupon and include with your payment in the enclosed envelope.
See Reverse for Terms & Gonditions, which are part of this Agreement
wherein United Site Services of Colorado, lnc. is referred to as "Company"
JOHN KNIGHT
Customer lD:
lnvoice Number:
Our Order No:
Please
Remit to:
uss-434988
'114-6027527
0-1227263
Subject to Tax
0.00
Exempt from Tax
498.30
United Site Services
PO Box 53267
Phoenix, AZ 85072-3267
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Total 498.30
Amount Paid:
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Check this box ¡f you would like to pay by credit €rd,
changê your address or decl¡ne dâmage wa¡ver, and you
have completed thê necêssary form(s) on the reverse.
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UnítedUnited Site Services of Golorado, Inc.
Customer Service: 1-800-864-5387
Biil
To:
JOHN KNIGHT
20 cR 316
stLT, co 81652
$trgsñRv¡*E*I
INVOICE
Customer lD:
lnvoice No:
Terms:
P.O. No:
Our Order No:
lnvoice Date:
Page: 1
uss-434988
114-6027527
Due Upon Receipt
o-1227263
11t13t17
Ship
To:
JOHN KNIGHT
20 cR 316
srLT, co 8'1652
Item / Description Quantity Term From / Thru Unit Price Total Price
CUSTOWN
KNIGHT SEPTIC Customer Owned
EEC
EnvironmenVEnergy/Corrtpliance
I Misc.11t10t17
11t10t17
0.00 0.00
0.00
Each
OT-SEPTIC
Septic Cleaning One Time Svc
OT-SEPTICGAL
Septic Disposal (per Gal)
S.SITEINSPE
Septic - Site lnspection
lncluded
EEC
Environ menUEnergy/Compliance
1
Each
750
Gallon
Each
1
11t10t17
11t10t17
11t10t17
11t10t17
11t10t17
11t10117
200.00
0.32
0.00
200.00
240.00
0.00
58.30
glr[
005 Powerline Rd.
Rifle, CO 81650
970-625-5556
Date: I I ¡7
Individual Sewage Disposal System
(rSDS) Reporr
I F
Customer Name:nt
Address:
E-mail Address:
Septic Tank (Size
Location of Tank:
Depth to Lids:
Clean Out Location:
Leach Field Side of Tank Condition:
Amount of Solids:l11 t rLta ILeach Field Outlet Condition:
ln Gallons ooo Lids I or Ð
Pipe
Showing Signs of Sludge in Line:
Solid Side of Tank Inler pipe Condition:
Level of Sludge:
Back Flushes:
Heavy Sludge
Customer Using Bacteria:
Yes or
on Bottom:
Comments:
Customer Signature: