HomeMy WebLinkAboutSeptic Pumping Slip - 258 REA STREET 2/29/2016 Commonwealth of Massachusetts RECEIVED
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System Pumping Recoid TOWN OF�X)RTH ANDOVER
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Facility Informato
ion:
System Location:
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Address
Ulty/Town
State Zip Code
System-Qwne,,
Name-
A ss�(if d�ifferent�from location�of pu�mp)
City/Town State Zip Code
C)
Telephone Number
Date of Pumpin 9_ 4 C_ _-- Quantity Pumped_4 (")
gallons
Type O'Sys'eM--\ septic Tank Grease Trap Other (what)
system Pumped by:
Comp y: O R-
-4'P
an ROTEMAN' 6 Portland Street Lawrence,NIA 01 843
Location where contents were disposed:
Signature Of Hauler '
fmA /v Date
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