HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 767 JOHNSON STREET 7/16/2019 w
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may,be"used,but the
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local Board of Health t6 determine the forrh they use. TbeSystem Purnping Record must be l
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Location:I System front of house, Left RI s r d
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Right side of building, Left i µ i i w ,
Address
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System w ,
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Name
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Cilwown
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Staff w ICode
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Telephonebey '
b-n—Ppmpiffing Record
. Date i 2 u6 Pumped
w Date Gallons
Tillight Tank
3. Type,of sy�terff: Cesspool(s) Tank
El Other
(describe),
Filter4. Effluent,'Tee nth' Yes 0 If yes,,, was it cleaned? El Yes [:1 No,
. Condifion
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'System :
Nell,Bates7on F5821
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Name Vehicle l s umber w
Batesion Ehiterprises Ina
Complany
7. Lo w �here contents-contents-were disposed.
Lowell Waste Waterw
Sig
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n a Hi"UI Date
Pumping Record Pw