HomeMy WebLinkAboutSeptic Pumping Slip - 808 JOHNSON STREET 5/30/2017 ID
Commonwealth of Massachusefts
City/Town Of 0, rWA-6 j o,
System Pumping o
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t
DEP has prwkted#ft ftft for use by local 1louds of HOMM.Other forms may be used,but the
Ntllbrr%Mlcn mast be sWtand *the + that provided here.Beuren this form,dick with your
Io001 Dowd of HUM to deler mine the form thehl use,The System Pumper Record MUM be Submitted to
tM 110001 Boand of NOW or other approving authority within 14 days from the pumping dam In
acoordarrce with 310 CMR 15.351.
A. Facility Into axon -
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5A I. Sworn LOOMM:
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Zip Code
2. Sydem Owner.
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pt cadn ,...,
a. Pumping rd► T
1, Dab of pumpingDi w. 2. Quantdty Pum tc. a
Gelwft
3. component13 e) ❑ter Tank ❑ Tight Tank ❑ Gresse T
rap
13 Other( ):
4• Iftuent Tee FMW prown ❑ Yes ❑ No N YGO,wM4 it cleaned? ❑ Yes ❑ No
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of component purnped:
e. System P
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