HomeMy WebLinkAbout- Septic Pumping Slip - 41 NORTH CROSS ROAD 6/13/2019 irri% �i ,; l � ��I %,r iCommonwea' lth
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AF A&P. Pumping Record
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DEP has provided this form for usev y l� l Boards,otHlealth. Ot h forma may'be*used,, but the
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1 yinfo Boardr .' Pumping Record
the I Board,of Health or other approvingAs Facill"Ity Inform' afloon
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1. System Location. Left R" ht�rof house, Left I
e of'building, Left R ght fr6n it of - r rcif builft' g,i h
Right siear 6f I
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r reck
Address
GROOM state Zip Coda
.I System
Name'
Address to
ci owe
t
t
Telephone Number
B. Plumpling
Record
s
Pumping1 Date of w
an r Gallons
3. Type-ofsystem: C s s, j�c � nk ugh Tank
Other(describe):
es, was i
4. EffluentTee Filter present? Yes If Y ft cleaned? Ej Yes [:1 No
49
5. Co��syd'N, i .. ,
r
6. System
Pumped
By,,-
Nell.
Name Vehicle! Number
Ina
Company
7. Locafio em"a content&were dlsposed.
l......lWaste Water
A
VAN
z
Date
15tbrmCd000 System PumpingRecord a Page