HomeMy WebLinkAboutSeptic Pumping Slip - 110 FARNUM STREET 8/7/2015 1
Commonwealth of Massachusetts
City/Town of 6 & 'MU,rf
System Pumping Record
Facility Information:
System Location:
C . �r
Address
i- fw
CA /Town
Stat6 Zip Code
System Owner:
Name:
Adress(if different from location of pump)
City/Town State Zip Code
Telephone Number
Pumping Record
M
Date of Pumping ` Quantity Pumped gallons
Type of System , Septic Tank Grease Trap Other. (what)
System Pumped by: �,' �� . I e/ ,Z)
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Company: ROOTER-MAN 46 Portland Street Lawrence,MA 01843
Location where contents were disposed:
Signature ofHaulerf Date �,/
