HomeMy WebLinkAboutSeptic Pumping Slip - 139 Vest Way - 10/31/2024 - Septic Pumping Slip - 139 VEST WAY 10/31/2024 ell
Commonwealth of Massachusetts
p City/Town of
i" System Pumping Record
xa Form 4
DEP has provided this form for Use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with your
local Board of Health to determine the form they use. The System Pumping Record Must be submitted to
the local Board of Health or other approving authority within '14 days from .he pumping date in
accordance with 310 CMR 15-35", --------
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A. Facility Informatior-1 BUiLDIN rent 6 ack side rear left right
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Telephone Number
B. Pumping Record
3,
1, Date of PUrnping Date 2, Quantity Pumped'.Pumped'. Gallons
3, Cornponent: esspool(s) Septic Tank Tight Tank ❑ Grease Trap
Other (describe)
4, Effluent Tee Filter present? ❑ Yes o If yes, was it cleaned? ❑ Yes ❑ No
5. Observed condition of component purnped:
------------- --------
6, System Purnped By:
Dave I iney., Mass 1AA95E Mass IAD31Z
Name Vehicle Ucense Number
Bateson Enterprises, Inc
Company
7, Location where contents ire disposed
GL5D
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Signatures of Haule( date ------------- ...............
Signature of Receiving f-'acillty (or atta&i facility receipt} Date
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