HomeMy WebLinkAbout- Septic Pumping Slip - 370 SUMMER STREET 5/1/2019 t i ;
�II Commonweaft h of Massachusefts
Uty/Town of
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System M Pumping
Record
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DEP has provilded this form, for use;by local Boards of-Health. Other,formit may,beused,
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information- � l r using.this, ,check with,your
Healthloc6l Board of i
the local Board of Healthr other appr ing .
A. Facility InforMation,
1. System i a RightR r i M right
'5: housii�
Right side of building,, i it 1 rear o building,
Address
11 C2 A
U V,%,\
�A
I PC- U
C � -stag ZIP Code
,1 System Owner.
Address(if different from location
Citynown Stater dis
Telephone
B. Pumping
Pumping1. Date of Yate 'nPumped:
. pooi(s) Z��,, Pfic Tank Ej Tight Tank
�her(describe):4. Effluent Tee Filter present? El Yes [j No If yies, was it cleanied? Yes No
51. Condifion of System:
6. System Pump
ft Bad i � F68,21
Narne 'VehicleLicense Number,
ateson EMe!pri es Inc
Com1 i
Location where content&were disposed.
,_ S. Lowell Waste Water
dp
SignAtule J_Hiii Date