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�� + ACCURATE SEPTIC
(3 COD Pld,LLING P.O. #
' } SERVICES, INC.
ASH $ Zip Code
�
4120 Selvitz Road
(1 CHECK # Security Code
Fort Pierce, FL 34981
CP CREDIT CARD #
772.489 -4411 • (772) 489-7778 Fax
Auth. # Exp. Date
C
/FEvauatl4n Sheet Tank �GreaseTrap Q Normal Level
re
HOURLY-S, G, OR H HOURS
GALLONS
Tank GGrease Trap (3Level Above
SEPTAGE - S GALLONS
GREASE - G
Normal
SLUDGE HAULING - H GALLONS
Septic Tank structurally sound
Drainfield of FAILURE
DUMP FEES - S SAND REMOVAL - S
0 S
showingsigns
OSTDS CERTIFICATION - S OTHER -
Deflection device Installed in outlet of tank
VACTOR SERVICES -V ITRUCK#
(j Outlet filter Installed in deflection device
VACTOR CAM - v
Excessive f]1 Grease Waste
VIDEO TAPE - v TIME: IN UT 42
Roots 13Sand
• l: •
13 IN TANK Q IN LINES
FLAT RATE JOB'- P FLAT RATE JOB - B
13 Potential plumbing problem
LABOR- P LABOR - B
13 Customer requested a proposal for additional work
LABOR - 2ND TECH - P LABOR - 2ND TECH - B
Customer requested a ACMS agreement
PLUMBING PARTS - P BACKFLOW PARTS - B
i3 ACMS customer
OTHER MATERIALS - P OTHER MATERIALS - B
Customer requested a Drainfield Estimate
RENTAL EQUIPMENT.- P OUTLET FILTER
SERVICE CHARGE - P CLEANING
ON CALL - After Hours Emergency Service
Bch
ESTIMATE/TROUBLESHOOT ONLY - P
VIDEO CAMERA - C Inspection Gator Cam Q SeeSnake
rec• - nds the• • wincy
i3
D/F Rejuvenation New Drainfield
VIDEO TAPE • C
��
Need new septic Iid installed New Tank
p
UNDERGROUND LOCATION - u 61 Gator-locate � Ardy-Eff
Installing outlet baffle (1 Hydro Jetting
LEAK DETECTION
outlet filter device (3Video Camera
SOD INSTALLATION
'Installing
'Biological Treatment (3ACMAupgrade
BACKHOE SERVICES L3 MINI EXCAVATOR
Vactor (Vac -con) Services i9 Root treatment
• - AIN CLEANING SERVICES90THER
Accurate Care Maintenance QAddt'i repairs
SEWER MAIN FLOOR DRAIN - F DISHWASHER
See Comments Below ® Other
COMMODE - a KITCHEN SINK - k TUB
' " • •
URINAL B/R SINK SHOWER
2ND LINE CLN - d (See Coments) LAUNDRY
131 Does Not Apply (3130 Days
(3 NO GUARANTEE*** (3 90 Days
3RD LINE CLN - d ROOF DRAIN
24 24 Hours 01-Year
HYDRO JETTING SVC. - j ROOF DRAIN
WHOLE HOUSE SPECIAL - D
Clean out manhole floor drain
roof vent under sink commode
ADDITIONAL'7
S/T inlet line pulled commode tub drain
catch basin laundry vent urinal
other (see comments section to left) vent
LIFT
-STATION
LABOR"- L FLAT RATE -JOB - L
LABOR - 2ND TE - L LIFT STATION PARTS - L
j 1 OTHER - L
• , • • •
I authorize Accuratesepucto perform the described services and I agree to pay
the amounts indicated above,
13 PIPE SHIELD - 1/2 GALS
® PIPE SHIELD - 1 GALS
® PIPE SHIELD - 5 GALS
Customer's Authorization Signature
i3 ROOT TREATMENT
i3 G/T TREATMENT
AuthodzingAgent's Printed Name
• • •
I authorize Accurate Septic to pelormthe described services and I agreeto pay
G FLOATING L/S TREATMENT
the ar�punt i�� dabo� A�6
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® AUTOMATIC BOWL CLEANER
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$35.00or5%(whichever is greater) Service Charge forallReturned Checks.