58R BROADWAY SEPTIC SYSTEM PUMPING RECORD 10/31/97 }'r.
toy Forest St. PSN FORM 4- SYSTEAI PM17 NG RECORD `.
Middleton,(508)774-2772 5E4SS� yOG
Commonwealth of Massachusetts
NOV 12 M7
1917 , Massachusetts CITY OF SALEM
HEALTH DEPT.
System Pumping Record
System timer System Location
neQC>j �f�y
Date of Pumping: Quantity Pumped: gallons
Cesspool: No ❑ Yes ❑ Septic Tank: No ❑ Yes ❑
System Pumped by: —eo r � � License #: :.
Contents transferred to:
Date f'17 f "l -7 Inspector 7, +
• THE PROFESSIONAL EXPERTS IN THE SEPTIC AND DRAIN INDUSTRY•