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HomeMy WebLinkAboutGrease Trap - Septic Pumping Slip - 550 TURNPIKE STREET 9/27/2022 . � RECEIVE Massachusetts 2 24?Z - = O -1 Of Norndaver sip ' stan-� �� T09t � �� � ...TOWN N °ERQAR_ M THFenn Al EN DER him pmidded ibis wrist fir use by facial Boards of Heat_Other ti rms MEW be t ih�V4 infor niagon must be substmMly the same as ul.-t provided here.Before UeIng his€arty,dwmt Ufilh y8 local hoard o,Health iz dekBnime the fbrrn ihey use,The$yawn Pu rrtping Recant muei:ba submyftd is the local Board O 1-eIM h or ather epproving auttoft uv!'ffm 14 days Rom ihs PuMt piric�d3`te in accordance shin sic CMR T5 Si- A. F&OB'Obj Enfo ngam �r%II3arbrthtr fmn illfngauMmi s `l- -aSysiv fi L.(ocaffon: use only the tab 1 \J k--y to mova your Address cursor-do not 1SE[11E rctZlrP �►/ j t/ cey. Gitytiauun i- TM Code f?- Syts M Owner'. 1 Name Address(atratrc irflr[iotionj CRY/-I +"M Sra� Zip code ' Telephone Aurrtbat- I. Li�e of Pumping ©ate I Qua•ti'rty Pumped: --- �altans 3. Component 01 Cesspags) Tj septic—,alkTiglr Tank � �raase"rapv 'F Other(ClcaGribe): ". Muerl Tee Firtar present? n s (No i,ya%waa it cleaned` r Yea :j:3 into ° �. Obswved condiifon OF e9-ralponent purtiped: 6. 5ysteM Pumped Sir- Name R Vahlots t fcense NlStYttler G'cmAarrJ t T- !Ocedc 7 Wherir canfe ttwre disposed: qqtl- 1"1'7, S,g iaufr ortisuIe: -Data ( a- S Fi3ftICc i Reci311iiiriJ Fats ii it(ore ch f�aT[fiJ Pl} Dam 'AS ormuoup i-itia 5iysrem Plimpiror Reca,d.Fage-r o``i