HomeMy WebLinkAboutSeptic Pumping Slip - 86 WILLOW RIDGE ROAD 7/5/2018 Commonwealth mfMassachusetts
City/Town of NORTH ANDOVER, MASSACHUSETTS
System Pumping Record '
Form
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A. Facility Information
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2. System
Name
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Address(if different from location)
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B. Pumping Record
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1. Date of Pumping 2. Quantity Pumped:
Date Gallons
3. Type ofsystem: Cesspool(s) F4Septic Tank El Tight Tank
LJ Other(describe): ------------
4. Effluent Tee Filter present? M Yes No |fyes,was|tcleaned? 0 Yes El No
5. Condition ofSyohem�
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8. System Pumped By.
Name
Vehicle L cense Number
Wind River Environmental
T. Location where contents were disposed:
Signature of Hauler Date
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