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~EPTIC TANK ABANDONMENT <br /> <br />WAS PUMPED BY: <br /> <br />DATE TANK PUMPED: <br /> <br />~icensed D~E.~. pumper) · <br /> <br />THE TANK WAS: <br /> [ ] REMOVED <br /> <br />FILLED <br />(note: the bottom of the tank should be per- <br />forated or cracked to prohibit the accumula- <br />tion of surface water in the tank) <br /> <br /> FILL <br />ENCLOSE A <br /> <br />MATERIAL: <br />[ ] REJECT SAND <br />[ ] BAR RUN GRAVEL <br /> CRUSHED ROCK y~_ ~ ~ <br /> <br />COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> <br />SITE <br /> <br /> <br />