HomeMy WebLinkAbout- Septic Pumping Slip - 51 HAY MEADOW ROAD 6/4/2019 N Q
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Commonwegith of Massachuseffs
GRY/Town of
System Pumpino Record
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Form 4
DEP has provided this form for use;;by l r formit
information-musit be substantially thetame as that provided here. Before using.this fonr M 6heck with your
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the local h r i r
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Facility InforMatillon
System Location.- Left/Right front of house, Left/061�i Left right side of house, Left I
Right 1 Rbuilding,
Address
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State ZIP code
City/Town
Owner.2.1 System
Address i diff,erent from tocaW
City/Town StateCr P Code
�70
Telephone Number
.B. Pumping Record
V Z_5,1049
Date of,Purnping Date 2. Quimbty Pumped.-
Type-ofy latel_�P�ficTight k
Other(descrollbe).-,
. Effluent,Tee Filter present? BYes E] No If yes, was It,cleaned? N co
5. Condifion of System:
6. System Pumped y-
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Narine Vehicle License Number
Bateson Ehte!prises Inc-
Company
7. Location where content&were disposed-.,
Lowell Waste Water
sig4we CfHbljl 'Date
.d000 06/03 SystemPumping a r