17 CEDARCREST AVENUE SYSTEM PUMPING RECORDS y 0222034886 09106/2005
Commonwealth of Massachusetts Form 4--System Pumping Records%
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System Pumping Record
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System Owner System Location
Losolfo Tony Primary Home
7 Cedarcrest Rd 7 Cedarcrest Rd
Salem, MA, 01970 Salem, MA, 01970
(97B)-745-1320 x (978)-745-1320 x
Losolfo Tony
Type: Emergenc Routine
Cesspool: No Yes Septic Tank: No Y
Quantity es
Date of Pumping: �- ( it ed: '
�{ Q ty Pum p Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to:
Contents Disposed at:
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Date: Pumper Signature:
Condition of System/Other Comments
MA
CITY OF SALEM
BOARD OF HEALTH +
® Printed onrecycled paper Dep Approved Form-12/07/95
FORM 4-SYS UMPING RECORD
CURRIER
SEPTIC & DRAIN SERVICE ����D
107 FOREST STREET; MIDDLETON,MA 01949
(978) 774-2772 APR 13 1999
Q T v OF SALEM
HEALTH DEPT.
COMMONWEALTH OF MASSACHUSETTS
Sa Jeal MASSACHUSETTS
SYSTEM PUMPING RECORD
SYSTEM OWNER: SYSTEM LOCATION:
m�c(cey COAZ f(u4bl
17 Cea��rC(eS� l}v�
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DATE OF PUMPING: 3 - 30' g QUANTITY PUMPED: TOO GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO 0 YES Q
SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE
CONTENTS TRANSFERRED TO: S ES D
DATE: �- 3�-5�1 INSPECTOR:_ 4eQr/xf
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FORM 4 - SYSTEM PUMP,11pR-)11 1'CORD,
Commonwealth of Massachusetts ,_
Massachusetts
System Pumping Record HEA (DEPT.
System Owner ystem ocauon
j_ / 7
Type: Emer Routine
Cesspool: No Yes ptic Tank: No ❑ Yes [IDate of Pumping: Quantity Pumped: / gallons
System Pumped by (Company : �� Permit 4:
Contents transferred to:
.Contents disposed at:
e�7
Date S Pumper Sign
Condition of system/other comments:
DEP"PROVED FOAM-1'107/95
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Commonwealth of Massa setts h5 lyyJ
Massachuse
System Pumping Record
system f3wneiSystem Location
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Date of Putnpiq: ;7/7 / Quantity Pumped(-0C0gallons
Cesspool: No ❑ Yes 19" Septic Tank: No ❑ Yes ❑
System Pumped by:.. ........... License #: ._..................:......................._....._ ..........
Contents transferred to:
Date Inspector
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FORM 4 - SYSTEM PLl4PLNG RECORD
Commonwealth of Massachusetts
4,; e
Massachusetts FEB 2 p 1996
System Pumping Record .
System Owner System Location
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Date of Pumping: (�/!V�7 Quantity Pumped: t!l .gallons
Cesspool: No ❑ Yes LJ11", Septic Tank: No ❑ Yes ❑
System Pumped by:. �11v�-.._' ........`�� _ License #: .... .
Contents transferred to: :5;t
Date Inspector
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