HomeMy WebLinkAbout- Septic Pumping Slip - 60 SUNSET ROCK ROAD 5/1/2019 u
Commonwealth
/ f
of,
Cfty/Town of
Massachusefts
s
f ,� R
1 Record
A i
'11, ,System Pumpino y'�9/
..
4
DEP has
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J
_FOV11"ded this form for use,, I'MI Boards of'Health. Other,form may'beused,but the
information,must be subst6ndally the tame as that provided here. Before usi,rigthis form,check with your
local Board f Health t6 determine the forte they use. The,$ystem Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility Infor M' afloon
1
1
. System Location.# Le . L rightsio e,
i side off" i'l i , Right6 ild i � u l n , n+
Address
C�Town S Zip Code
2. Sn Owner
Name
Address OfAffemint from l on)
Uvrown � fe,7D
Telephone Number
Pecord
.B. Pumping
'0�
LT
I Date of, jI µ . Purn , ,:
Date 1ls
l T a n k El Tight
Other(describe):
4. Effluent Tee Filter present? Yes yes,, was it cleaned? Yes No
avol if
. Condifion,
Aj
. System Pumped B
Nei!,BateSF09 2 '
Name Vehicle License Number
Bateson EhteM!!E��
Company
7. Locafifio re contents were disposed:
Lowell Waste Water
MW
Sign Date
a
. , System Pumping Record, Page