HomeMy WebLinkAboutSeptic Pumping Slip - 336 CANDLESTICK ROAD 12/28/2016 Commonwealth Massachusefts
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Sy�tem Pumping.Record
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®EP has provided this form for use-by local Boards of Health. Other forms may be us l but the
information must be substantially the tame as that provided here. Before using.this form,check with your
local Board of Health to determine the forth they use. The Systern Pumping Record mint be submitted to
the local Board of Health or other approving authority.
A. Facill,ty. Inf o ti
I. System Lo do Kdift1q,- Righter �f�qu , Left 1 Right rear of house, Left/right side of house, Left/
Right side of b Left/Right fr6nt of building, Left/Right rear of building, Under dept(
Address
'rty/1 augrn State Zip Code
2'. System Owner.
�cz
Name`
Address(if different from location) --
City/Town ' stag)�. Zip Cade
"telephone Number f,�.
i
Po;mping Record
1. Date of Pumping rate 2. Q ntity Pumped: Gallons
. Type-of system: Cesspool(s) ( eptic Tank El Tight Tank
Other(describe):
4. Effluent Tee Filter present? Yep o if yes, was it cleaned? [ Yes Cj No
. Condition of System,
6: System Pumped By:
Pfeil.Batesan - F5821
Name Vehicle License Number
Sateson Enterprises Inc
Company
7. L7L G. n".-
mere contents.were disposed:
} Lowell Waste lrtilafer
- F
Sign Haul Cate
t5fbrnt4.doc-06103 System Pumping record Page 9 of°I
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