HomeMy WebLinkAbout- Septic Pumping Slip - 675 FOSTER STREET 12/13/2021 A. Facility Inforri�ation
1. System Location: Left/Right front of house, Left]Right rear of house, Left/right side of house, Left
Rig side of building, Left/Right font of building, Left/ 'ght re of building, Under deck
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2. Sy tern Owner.
Name
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Address(if different from location)
MA
Cityrrown Stat Z' Code
Telephone Number
B. Pumping Record
1. Date of Pumping Date 2. Quantity Pumped: Gallons
3. Component: ❑ Cesspool(s) ❑ Septic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other(describe):
4. Effluent Tee Filter present? ❑ Yes ❑ No If yes,was it cleaned? ❑ Yes ❑ No
5. Observed condition of component pumped:
6. System Pumped By:
David Tiney Mass F5821
Name Vehicle License Number
Bateson Enterprises, Inc.
Company
7. Location where contents were disposed:
GLSD Lowell Waste Water
Signature of Hauler Date