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SEPTIC TANK ABANDONMENT <br /> <br />THE SEPTIC TANK AT: <br /> <br />WAS PUMPED BY: <br /> <br />DATE TANK PUMPED: <br /> <br />THE TAN~WAS: <br /> ['VQ REMOVED <br /> <br /> [ ] FILLED <br /> <br /> FILL MATERIAL: <br /> <br />(licensed D.E.Q. pumper) <br /> <br />[ ] REJECT SAND <br />[ ] BAR RUN GRAVEL <br />[ ] CRUSHED ROCK <br /> <br />ENCLOSE A COPY OF THE PUMPING RECEIPT WITH THIS FORM. <br /> <br />PERMIT #: <br /> <br />SITE #: <br /> <br />DATE: <br /> <br /> <br />