HomeMy WebLinkAbout- Septic Pumping Slip - 5/14/2019 f
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accordance With 310 CMR Mustbe submitted to
Board of Health or 6ther SIPProving authority with In 14 days fro
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2. System Owner; zip Codb
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Address,(If different from jtl
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Zip Codo
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" Umping Record
Date OtPuMpIng
Date 2, Qua w .,,
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1 Septlo Tank
Ight TankC] G
El Other(describe),,
Trap
4. Effluent Tee FlIter Present?
f' ,was It cleaned? yes
5. No
Observed condition Of cOmPonent Pumped.,
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ped By:
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Signature o w
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Signature of Receiving Foollity(Ior attach faC11,11y
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