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THE SEPTIC TANK AT: <br /> <br />(licen-~ed D.E.Q. pumper) <br /> <br />DATE TANK PUI~PED~ <br /> <br />THE TANK WAS: <br /> [ ] tLEMOVED <br /> <br />FILLED <br />(note: the bottom ~f 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 /> <br />MATFiRIAL: <br /> REJECT SAND <br /> BAR RUN GRAVEL <br /> CRUSHED iROCK <br /> OTHER: <br /> <br />ENCLOSE A .C. OP/~/ OF ~R PUMPING RECEIPT WITH THIS FORM. <br />SITE ~: <br /> <br /> <br />