HomeMy WebLinkAbout- Septic Pumping Slip - 316 RALEIGH TAVERN LANE 6/4/2019 Commonwealth
. of' Massachusetts FZDo
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City/Town ot
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System Pumping Record
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Form 4
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DEP has provided this form for use�by to l' rd' -Health. etherfoirmt;maybeused,but the
Informa, flon,must be substinfially
loc6l Board'of Health to,determine the forrh they use. The$ystem Pumping Record must be submitted
to
the local Board of Health or other approving!authority.
I.A,., Facil"Ity Inform" ation
System � atfon. Left/Right from,olf house, Left �� r r �house, e � i � . o
Right side-of building, Left I Right fr6nt of building, LeftRight rear bf building, Under Ad'dress
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C /Tows state Zip Cede
2. System r*
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Name'
Address Of differentfrom t flora)
ciltymwn
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Telephony Number
.B. Pumping Kecord
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Date,of
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Pumping . i
Date Ins
., Type-of system: C l s, [D--�epfic ink DTIght Other cr*j )
. Effluent Tee Filter r rat? 0 Yes, of cleaned?
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System
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Name Vehicle Ucense Number
Bateson EhteTrises InC
Company
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fill, a content& rdisposedal
G.L S, Lowell Waste Water
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Sign 0 Hhul date
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t51brm4.da,ca 06/03 System Pumping Record
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