HomeMy WebLinkAbout- Septic Pumping Slip - 623 OSGOOD STREET 5/1/2019 f r I� Oi L f it Iprn�/�IW
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Commonwealth ot" Ma, ssachusetts
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Form, 4
DEP has'provided this form for use-by local Boards of,Health. Other formis may"be'Used, but the
information*must be subst6nfially the same as that
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providedhere. Before usingthisform, '
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your
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localthe roving
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A. Facility Infor
Mation
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Systemti : Left, iht ront, i h r of , right side of, , Left I
Right i it i i gUnder, Left Right rear . T
Address
cityrrown state Zip Coda
�Z. System Owner.
Name
Actress Of different from,l
CIRWOM sta!l de
Telephone Number
.,B. Pumping Keeord
F14 3
tic Tel. Other
(describe): ...........
. Effluent Tee Filternth" El Y 'l Yes No
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System6. y
Nell, 7
Name Vehicle
Company
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0&0-0- LowellWaste Water
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t5formkdoca,06/03 System Pumping Record
