HomeMy WebLinkAboutSeptic Pumping Slip - 66 PENNI LANE 8/7/2015 I
1
Commonwealth of Massachusetts
City/Town of
System Pumpin �RN' e4ctordhl
Facility Information:
System Location:
Address
K o(4�1'�\ t 1'),�'dxvj
City/Town State Zip Code
System Owner:
Name:
Adress(if different from location of pump)
City/Town State Zip Code
Telephone Number
Pumping Record
Date of Pumping " 1 Quantity Pumped .. gallons
Type of System X Septic Tank Grease Trap Other (what)
System Pumped by:
Company: ROOTER-MAN 46 Portland Street Lawrence,MA 01843
Location where contents were, isposed:
Signature of Hauler , ' Date ' f