HomeMy WebLinkAbout- Septic Pumping Slip - 32 BANNAN DRIVE 6/13/2019 � li V«w
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System Pumplong Record T(
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Form 4
DEP has provided this form for v local Boards offlealth. Other formis 'Used,but
information,must be subst6rifially the bame as that,provided here. Blefore using Ahis form,c*heck with your
local HealthBoard of . T he.Systern Pumping Record must be submitted to
the I l v
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1. System Location: Left Right front of house, Le,A., Faclifty Inform' aflion
Right i
ig rear uildina, Under deck
i
Address,
C!tyfrown Cody
Owner,2, System,
Name
Address from to
City/Town1' �"F�odo
Telephone Number
. . PUM ping
Date o �Pumping � 2� LY r Pu, d.
DateGallons
., ° l' <ic Tan k. 'Tii
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0 Other
(describe)-
4.
Filter, Y Yes 0
Condition5. y- i
. System Pumped By*-
Nell,
Name Vehicle License Number
Bateson EhteTrIses Ina
Company
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Lowell Waste Water
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Sign qf Hhule Date,,
. o 06/03 System Pumping Record page