SYSTEM PUMPING RECORDS FORM 4 - SYSTEM PUMPING RECORD
Commonwealth of Massachusetts T
Massachusetts OCT 202063
System Pumping Record CITY OF SALEM
BOARD OF+I-E;i�
ystem 0caner System Location
ell
Type: Emergency [� _ Routine
Cesspool: No ❑ Yes Septic Tank: No ❑ Yes ❑
Date of Pumping:'' �p/ Quantity Pumped: gallons
System Pumped by (Company): I� ay Permit 4:
Contents transferred to:
Contents disposed at:
REA, is P ,
Date -f Pumper Signature
i
Condition of system/other comm
DEP APPROVED FORM. I2/07/95
107 Forest St. FORM 4- SY i PUA
' :308)idlet7 4. 07 2 ��N RECORD
508)774.2772 .rGb�,E
SEQ gER
Commonwealth of Massachusetts SEP S 1997
2C4 t`� t^g_ , Massachusetts CITY Qr
112AI. I-I DER(.
System PrmDing Record
stem "Mer
ystem ocatton
Vl� a cc�e y Cc n
v fo
Dale of Pumping:
Quantity Pumped: 4�allons
Cesspool: No ❑ Yes Septic Tank: No ❑ ❑
Yes
.stem Pumped by: �/l --��''� fib
ontents transferred to: License #: _
Inspector•
• THE PROFESSIONAL EXPERTS IN THE SEPTIC AND DRAIN INDUSTRY •
MA
� FQR1114- SYS'IE?�( PUMPINGRECO};1)
d 107Fleton,MA 01949
508) 774-2772 _„TCU�{,�
d .RIF
Commonwealth of Massachusetts $cp U 1997
Massachusetts
CITY OF SAt;,.I
Svstem Funning ecord
�stem Nner
ystem Location --
Ckey CC
i I
Lo
�� -
:?'Ite of Pumping: '447 Quantity Pumped: Cl allons
esspool: No ❑ Yes Septic Tank: No ❑ Yes ❑
stern
transferred to: �rl.`ex- 5gWA/G
Pumped
License
Inspector G,
• THE PROFESSIONAL EXPERTS IN THE SEPTIC AND DRAIN W(jb jSl;tY 0