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THE SEPTIC TANK <br /> <br />WAS PUMPED BY: <br /> <br />DATE TANK PU~PED: <br /> <br />(licensed D.E.Q~ put, per) <br /> <br />THE TANK WAS: <br /> ~ REMOVED <br /> <br />FILLED <br /> <br />FILL M~ATERIAL: <br /> [ ] REJECT SAND <br /> [ ] BAR RUN GRAVEL <br /> [ ] CRUSHED ROCK <br /> <br />ENCLOSE A COPY OF THE PUMPING RECEIPT W~TH THIS FORM. <br /> <br />SITE <br /> <br />DATE: <br /> <br /> <br />