JO NO.			METER NO.
DATE & TIME OF COLLECTION			BOOK
SLUDGE/SEPTAGE ORIGIN
CUSTOMER NAME			SIGNATURE
ACCOUNT NO.			CONTACT NO.

ADDRESS

Proof of satisfaction of service verified and confirmed by the customer. Customer signature will be valid proof for the completion of service and truthfulness of observation/assessment. The customer may opt to allow SOLIMAN personnel to open their septic tank provided that the customer waives the liability/responsibility of SOLIMAN in case of damage to property.

SLUDGE/SEPTAGE SOURCE
				VOLUME (CUBIC METERS)
RESIDENTIAL		[  ]
COMMERCIAL		[  ]
GOVERNMENT		[  ]
INDUSTRIAL		[  ]
INSTITUTION		[  ]

Commercial/Industrial waste must be sampled and tested before ot is off-loaded at the treatment facility to ensure that the material won't contaminate the treatment process. Contamination can be caused by grease oil/oil/metals, and chemicals.

Description of Commercial/Industrial Water

DESLUDGER/TRANSPORTER/TREATER INFORMATION
COMPANY	SOLIMAN E.C. SEPTIC TANK DISPOSAL
ADDRESS	UNIT 2 EPI-DEANS BUILDING, MAC ARTHUR HI-WAY, SINDALAN, CITY OF SAN FERNANDO, PAMPANGA
CONTACT NO.
NAME OF DRIVER
DRIVER'S LICENSE NO.			OTHER PERSONNEL
TYPE OF TREATMENT/DISPOSAL
DATE & TIME OF DISPOSAL			NAME & SIGNATURE OF REPRESENTATIVE
DATE & TIME OF EXIT

OBSERVATION/ASSESSMENT
SPILLS	YES	[  ]	NO	[  ]
LEAKAGE	YES	[  ]	NO	[  ]
AVAILABILITY OF STANDARD SAFETY EQUIPMENT	YES	[  ]	NO	[  ]
LIST/STATE OTHER VIOLATIONS (IF ANY)