HomeMy WebLinkAbout- Septic Pumping Slip - 296 BOSTON STREET 6/17/2019 � J
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System Pum
plung Record
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Form, 4
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DE,P ha's provided this form for use bY 10ca!Board's of Health. Other for'ms may be used, butthe
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local Board of Health to �F
the local Boa' mini the nnn they use "� e S �'em �rn lIng-Rec r must e sub b I l
rd of Health e approving arwithin
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accordance with 3 1,0 CZAR 15 35 1.
Information
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Pumpinq Record
I. Date of Pumping 2. Quantity Pumped,* Gallons
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Component:
El Cess,pool(s) eSeptic Tank, El Tight Tank Ej Grease T'rap
. 'Effluent Tee lIft r resent ' yies
jT yeS,, Was it cleaned Yes
El No
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Wind River Environmental
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Location ere contents were disposed, .W.
" �'ich,
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receipt)Signature of Recoelving Facjli�-y(or attach facility
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System i
Plumping Record' Page 11 1