HomeMy WebLinkAbout- Septic Pumping Slip - 261 REA STREET 6/13/2019 �N E C
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onwealth ofMassachusefts
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k ,Jauf u,�System Pumping Record �'�'"wll�6 UI'wsu j
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determineForm 4
DEP has provided thi's form for use;;by local Boards of-Health. Othe:r foirmt;may,bobsed, but the
information,must be subst6ritially the tame as that,providedhere. Before using.this form,check with your
loc6l Board of Health to r M' they use.TheSystem Pumping RecordL
the local Board,of Health or other approvingauthority.
A. Facility InforMation
w System on., house Left i reap house, , e right side house, Left I
Right� � � 1,9 � eq
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My/Town State zip Code
2"M System Owner,
Ilk
Address(if differeirit from location)[
Cotwown Sta
Telephone Number
B. Pumping Record
Date of Purnping i
d:
Date Gallons
I Type-of system: Cesspool(s) fic. k El Tight T n
Other(desctibe).,
I
4. Effl'uent Tee Filter
"" yes
6. EQ., 0
Condition
System:
Y
Systemy
lf,
Name Vehicle Ucense Number
Bateson E��rlses lnc
Company
7. Liocaalfi re content&were disposed:
1 L
Lowell Waste Water
Sign Hhul 4Dae
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