HomeMy WebLinkAbout- Septic Pumping Slip - 165 FOREST STREET 6/4/2019 *C#11SNIVED
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PumpingRecord
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A. Facility InforMation
ht rear of A 1
Left.,/right s"de of h�oulse, Left I. System Locations,, L64 U, nt, of hoys
Left/R119 chi=fro �01
Right i it rear . i Under deck,
Address ;z
cityfrown State Zip Code
2. System Owner.
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Address
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cityfrown Statr z
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Telephone Number
B. Pum, ping Record
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1. Date of Pumping Data 2. Qu6ntity Pumped: Gallons .... ------
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3. Type-of,system: Cess l s), a�,A5epflc Teak Tight Tank
Other(describe):,
4. Effluent Tee Filter,present.? Yes 0 If yes, was it cleaned? Yes No
. Condition
6. System Pumped
Nell.Batesbq F2
Name Vehicle License Nlumr
Bateson Ehte!pr*ises In M
Company
WaterLowell Waste,
Sign "'but [)ate;
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1 3 System Pumping Record Page
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