HomeMy WebLinkAboutSeptic Tank - Septic Pumping Slip - 370 FOSTER STREET 12/13/2021 A. FacHity Inforri�ation
1. Spstern Location: Left/Right font pf house, Left/Right rear of house, Left/right side of house, Left
Ri ht side f building,Left/Right front of building, Left/Right rear of building, Under deck
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2. System Owner.
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'Name
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Address(if different from location)
MA
City/Town State Zip Code
Telephone Number
B. Pumping Record
1. Date of Pumping2. Quantity Pumped: o
ate Gallons
3. Component: ❑ Cesspool(s) *Septic Tank ❑ Tight Tank ❑ Grease Trap
El Other(describe)_
4. Effluent Tee Filter present? ❑ YeSO�o 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. ati where contents were disposed:
L Lowell Waste Water
Signature of Hauler Date
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