HomeMy WebLinkAbout- Septic Pumping Slip - 125 COLONIAL AVENUE 5/1/2019 f
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Common Ith of Massachusefts
City/Town of
System Pumpino Record'
Form 4
DEP has
s
provided this form for ,,by local Boards of,Health. Other form may be'used,but the
information,
1=61 Board of Health to in fog they use.The$Ystem PumpingRecord must submi,fted to,
the local, Board of,Health or otheri authority.
A. Facilloty Inform' aflon
n(:LRigrr right
Right side wr ir�on r
Address
i
i own State Zip Code
System
Name,
1
Frees(Wdifferent from,to
1
CitwTwn ZIP&*
t
Telephone w m r
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1
B.
Pum"
Date W.W. Gallons
3. -off 11 ic Tank Tight,Taink
OtherE] (describe):
. Filter presentI Ej Y if . , cleaned? Yes No
Condition5.
u
Nell. F5 2
Name Vehicle Doense,Number
Bateson Ehte[prises Ina
i
1
Company� f
7. Location where n µ r, i
Lowell-Waste Water
Sign a qf'Haul Date
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