94 BRIDGE ST _i _
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107 Forest St. FORM 4- SYSTF I PUNIPING RECORD
Middleton,MA 01949 (;!¢
(sob)774-2772 5EP ��.t�GE
Commonwealth'of Massachusetts
Massachusetts NOV 2 A 1997
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Cl I Y OF SALEM
HEALTH DEPT,
System Purring Record
System ONviter system Location
Ile
Date of Pumping: � L�–f— Quantity Pumped: p gallons
Cesspool: No ❑ Yes ❑ Septic Tank: No ❑ Yes Lt
System Pumped by: C U�� `>� License #:
Contents transferred to: SL S
Date
Inspector
0 THE PROFESSIONAL EXPERTS IN THE SEPTIC AND DRAIN INDUSTRY 0