HomeMy WebLinkAboutSeptic Pumping Slip - 201 CARLTON LANE 11/16/2015 �
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Commonwealth of Ma_,;sarhuseyt `
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System Pumping Record '
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A. Facility Information
Important:When
filling out forms 1 System Location:
on the computer, / /-
use only the tab
key tv move your Address
cursor'unnot
North
uae�emmm --� - --'--- ------
key. ~'y''"~" State u~�~~~--- Zip Code
2. System Owner: A 9D1�
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Name / �-�' ----'-----'---------
Address(if-different fromIoa�n) __ ------- -''-- ---'
C�y�own �-------------' - - ----'------�-----
State Zip Code
/olepnonemumoe,
B. PUMPing Record -
1. Date of Pumping - 2� Quantity _5 on s
3. Type ofsystem: El (a) Septic Tank Fl Tight Tank El Grease Trap
El Other(describe)-
4. Effluent Tee Filter present? 0 Yes Ej No If yes, was hcl'ean--d? [_l Yes No
5. Condition of System:
_ .............- ......-------
O. System Pumped By: �
mame � - --
~___-
Vehicle License Number------
Stewart' Septic Service
Company ----- '-- --
7. Location where contents were disposed:
°u`wmtu Pre-treatment Plant, Bradford, Ma
Tignamreor:au�r ��----�----'-----' --------'--- ---'
8i gnamreof ece_iv ng paoi I,ty -'-- -' -�-' -'----' ----'- ---------------
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System Pumping Record-Page I of 1