HomeMy WebLinkAboutSeptic Pumping Slip - 326 CANDLESTICK ROAD 5/15/2017Co onwealth of Massachusetts
City/Town of
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ecord
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DEP has provided this form for use4v local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using.this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility informatiop
1. System Location: Le
Right side of building,
•
2. System Owner:
front of house)Left/ Right rear of house, Left/ right side of house, Left /
'ghtfront-oftUilding, Left / Right rear of building, Under deck
-ic t
State
Zip Code
Address (if different from location)
City/Town
P
gRe
1. Date of Pumping
3. Type of system':
0 Other (describe):
Telephone Number
2. Quantity Pumped:
Gallons
SicTank 0 Tight Tank
Date
Cesspool(s)
4. Effluent Tee Filter present? 0 Yes
5
C,2 (—EA/Va.J• (.e
Condition o tem: (
If yes, was it cleaned? 0 Yes 0 No,
6: System Pumped By:
Neil. Batesbr2 •
Name
Bateson Enterprises Inc.
Company
7. Lo
F5821
Vehicle License Number
contents were disposed:
Lowell Waste Water
1
Sign Haul
Date
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