HomeMy WebLinkAboutSeptic Pumping Slip - 326 Candlestick - Septic Pumping Slip - 326 CANDLESTICK ROAD 10/2/2024 Commonwealth of Massachusetts
City/Tovvn of
Wr
System Pumping Record
Form 4
DEP has provided this form for use by local BOafd5 of l�ealll . Other forms may be U3ed' but Ille
informalion must be substantially the same as th2l provided horn, 8ofora using this form, chocl<wilh your
local Board of Health to determine the form They use. The Systorn Pumping Record must be subrnftted to
Me local Board of Health or other approving authority within 14 days from the pumping date in
accordance with 310 CMR 15.351,
MOUSE: (ront acl< side rea ief ight i
A. aeility lnformafionBUILDING: ut back side rear left right
Important:When DECK: under
ruling oul rorms 1, System Location:
on the computer,
use only the tab
key to move your Address —
cursor •do no{
use the rolurn MA
Y. CI yfT0Wn — Stale —
ZIP Code
2. System Owner;
1 Name
rnrn
Address (if diHoranl rrorr?location) � ��
CIIyrTo rn _ MA
Slate Zlr)Code
Telephone min, er B. Pumping Record m
1. Date of Pumping Iv t
t 9 oate 2. Quantity Pumped: Gallons --
3• component: [] Cesspool(s) [� Septic Tank ❑ Tight Tank ❑ Grease Trap
❑ Other (describe): --
4. Effluent Tee Filter present? ❑ Yes xNo I! yes, was it cleaned? ❑ Yes [I No
5. Observed condition of component purnpeo:
& System Pt�rnped By
Dave Tiney _ Mass 1AA95E- Mass 1AD31
Na1Y1e Vahlcle License Num r
Bateson Enler>rises, Inc.
Company —
7. (a1)i n where contents were disposed:
GLSQ
Signature o! Hauler' Data
Slgnature pf Race In my Facility(orallach facility recelpl) Daie -- —.
15form4,doc 11[t2 System Pumping Record page } of }