HomeMy WebLinkAbout- Septic Pumping Slip - 186 BRADFORD STREET 5/1/2019 Commonwea
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DEP has provided this form,for useby local Board's of,Health. Other formt may'be*Used,but the
in substantially tame as eform, k wig your
1 1 It r �ystem Purnping rd must be submitted to
local,the Board of Healthr other r i
A. Facility InforMation
'ng authority.
1. System
Location: � rightµ , "
Right i " . .. 19
cif building, r deck
Address
cityfrown stateCode
, System Owner.
Address <;
differentfrom location)
Cityfrown Stater Zip Cod's
Telephone. *2�
-I 01_�
Number
B.
1
. DateGallons
3. . k
Other(describe):
e
Filter4. Effluent Tee
present,h Y Icleaned?
61. i "
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on of System,
. System Pumped
Nell.Batetbn F582
Name Vehicle License Number
Bateson Ehtemrises I
na
7. Locafipwwhere contenter were
, Lowell Waste Water
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Sign o9UHIBUI Date
. System a ping Record o Page l'of