HomeMy WebLinkAboutMiscellaneous - 119 LIBERTY STREET 4/30/2018 (3) RECEIVED
C° ®nwealth ®f Massachusetts MAY 12 Zoog
C� � � p ®� TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
System Duping Record
Facility acili ' Info
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System Location:
Address
cltv/Town Jwt V
State Zip Code
System Owner-
Name:
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Adress (if different from location of pump)
City/-To wn
State Zip Code o�
C� I
_ Telephone Number
PuTnp ng Rec®rd 1
I
Date of Pumping f
Quantity Dumped gallons
Type of System Septic Tank Grease Trap Other (what)
Systern Pumped by: )a
Company: ROOTER-MAN 12 East Dracut Rd., Methuen, MA 01844
Location where content were disposed:
Signature of Hauler K
Bate