HomeMy WebLinkAbout- Septic Pumping Slip - 115 COLONIAL AVENUE 5/7/2019 i ymoiip��aia�r !li�i✓i��i(I��k
LULL
Commonwealth of Massachusetts
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f o
C
ty/Town of
Pumpoino
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Al
System i d f rl t�ill !v �
vi,Form 4
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l
DEP
has provided fore for use4by local oars � 1 . th r � y be'used„ w the
�i must substantial) the same that providedhere. i check �,
10c6l Board of Health to determine the form' they s
the local Board of Health or other approving authority.,
As "IL
Y Information
1. System
i . l
, L
Right � l • it i , building, µ.Address
Cfty/,r(),Wn state Zip Code
.
1
Name'
Addressi T location)
ci
Telephone Number
w
.S.,
Pumping
1. l
Date of Pumping2. Qu6nfity Pumped.
tic Tank Ej Tight Tank
Other(describe):
4. Effluent Tee Fifter presen't? ED Yes D-Iro
6. Condition System:
JQ�
6. System Pumped
N1l�. Bates F5821
Name Vehicle License Number
Bates lss, Iia
company
i
A
ere contents were disposed:
I
� Y
Si l Date
6fb System Pumping Record page