HomeMy WebLinkAboutSeptic Pumping Slip - 65 BROOKVIEW DRIVE 8/3/2015(r)(1/20:4,1
Company: ROOTER -MAN 46 Portland Street Lawrence, MA 01843
Location where contents e spo ed:
Signature of Hauler
Commonwealth of Massachusetts
City/Town of il/dOti iktiov."
System Pumping Record
Facility Information:
System Location:
Address
f
City/Town
System Owner:
1;1(14 o'ciA) r)(
StatelqA
Zip Code
Name:
Adress (if different from location of pump)
City/Town
State Zip Code
1 )t5"
Telephone Number
Pumping Record
Date of Pumping (0 / //';'' Quantity Pumped
Type of System Septic Tank Grease Trap Other (what)
System Pumped by:
gallons
Commonwealth of Massachusetts
City/Town of 6,(4 /AILM
System Pumping Record
TOWN Of f\IORTVI
d HEALTH DF11,'"'ARTME NT
Facility Information:
System Location:
6rAr 0,0,W
Address
d/k fYt)
City/Town
System Owner:
P70.116e.r
Name:
State
Zip Zip Code
Adress (if different from location of pump)
City/Town State
Zip Code
606
Telephone Number
Pumping Record
Date of Pumping 7//t /7 (/ Quantity Pumped / )7-14) gallons
Type of System A Septic Tank Grease Trap Other (what)
System Pumped by:
Company: ROOTER -MAN 46 Portland Street Lawrence, MA 01843
Location where contents wer disposed: 313
Signature of Hauler
Commonwealth of Massachusetts
City/Town of 0,mA rry6p24
System Pumping Record
PO.c.11; ?Ol
P,Nj.i)ovER.
FIEP1.„.TH
Facility Information:
System Location:
bruk4,,i2 w
Address
Ai\ t,(0)A
City/Town
System Owner:
1270,0U-ii
Name:
A
State Zip Code
Adress (if different from location of pump)
City/Town
State Zip Code
Telephone Number
Pumping Record
Date of Pumping .70 ((
Type of SystemSeptic Tank
System Pumped by: CA s
Quantity Pumped
5a)
gallons
Grease Trap Other (what)
Company: ROOTER -MAN 46 Portland Street Lawrence, MA 01843
/I
Location where contents were disposed: (7i64)
Signature of Hauler
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to Inovo ytdor
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Name
Cothom;y
7, Location
2
HEAL.TH
Commonwealth of Massachusetts
City/Town of NoRTH‘ANppvER,,miats,s6c.„H,o
8y0070 Pumping Record
Forrn 4
oep has prMdLi this fortn for use by local Boards of Heath. The Sys
be submitted to the local Board of Health or other 8pprovirq.1 authority
FaeOity information
1 Systum LoccEition:
N Me
cl;ilyiTown
PuropiAg Reord
Date P 1.1 wiping
a. -Pipe of system:
Stitte
entity Pumped:
Crpool(s) El/Septic Tnnk
Other (describe):
4. Effluent Tee Filter present? [1 'Yes C:1 No
5, Condition (.3f systern:
System {rripci f3v:
_
"ontents wterG dispoaM:
g16;17;turo o4.iukit'
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t.,...ofrr,4,,Joc, 06(03
PAC.riE 021
Zip C,ode
Tight Tank
if yes, wes it cieaned? 71 Yes Li No
\A7t1i5le Nonibor
DAte,
System Purripiii9 Record • PagG of 1