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(licens6d D;E.Q. pumper) <br /> <br />THE TANK WAS: <br /> [ ] REMOVED <br /> <br />[ ] <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 MATERIAL: <br /> [ ] REJECT SAND <br /> [ ] BAR RUN GRAVEL <br /> CRUSH~D,~OCK- <br />ENCLOSE A C~' OF THE PUMPING RECEIPT WITH THIS FORM. <br /> <br />SITE #: <br /> <br /> <br />