HomeMy WebLinkAbout- Septic Pumping Slip - 80 SUTTON HILL ROAD 6/4/2019 �ii prrI rig;IVED
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Form 4
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DEP has'provided this form for a 4 , local Boards of flealth. Other formt ma,y'be"Used, 4ut the
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the lo,c:al Boardf Health or other approving authority.
Factlity Inform"ation
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2. System
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Address Of different fromi
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Telephone Number
Pumping Kecord
. Date of Pumping 2.
DateGallons
. Type-of system: I li k El Tightk.
Other(describe):
Filter4. Effluent,Tee nth 0 Yes E]---Wo---� if yes, was it cleaned? Yes No
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Condition
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Neff Bates7on F5821
Name Vehicle Lloense,Number
Bateson ri Inc-
Company
disposed:
Lowell Waste Water
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Sign 0 M3 Date
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, . 1 mping Recorda', of I