22 CEDARCREST AVENUE SYSTEM PUMPING RECORDS FORM 4 - SYSTEM PUNMING RECO F,D
Commonwealth of Massachusetts
Massachusetts
System .Pum-p ng Record
System caner 6ystern ocation
� �G{ u''rr�O.v' • a� C C�a vcc—���
Type. Emergency [� . Routine
Czsspoo1: No ❑ Yes Septic Tank: No ❑ Yes ❑
Date of Pumping: Quantity Pumped: zoea® gallons
S} s!em Pumped by (Company): / jl" � f� fv Permit
Contents transferred to:
.Contents disposed at:
Sa/ewe,
Dare Pumper8 �nature
Condition o t* <stem/other co encs:
0
SID , 11L
Ir JUL 12 2006
CITY OF SALEM
nEr APPROVED FORLi - 12/07/95 BOARD OF HEALTH
nfnl
FORM 4 - SYSTEM Pi�t;.REEO,AF
Commonwealth o Massachusetts E
f DEG-3 —1.003
Massachusetts
System Pumping Record BOA D oSALEM H
ystem Uwner 6ystem Location
6f11�/l0� Ceda11eCv2S .
Type: Emergency-,Q Routine l�/
Cesspool: No El Yes LQY , Septic Tank: No ❑ Yes ❑
Date of Pumping: /�/Q Quantity Pumped: e:�,D gallons
System Pumped by (Company): � gig rij Permit k:
Contents transferred to:
Contents disposed at:
Date err%% ' Pumper Signature
Condition of system other comments:
DEP,VTRO VFD FORM. 1:107195 .
FORMA - SYSTEM PUMPING RECORD
r
Commonwealth of Massachusetts
Massachusetts
System Pum-ping Record
System Owmer System Location
6au') �� c����-�,�s Ae
Type: Emergency-,(� Routine
Cesspool: No ❑ Yes `i' Septic Tank: No ❑ Yes ❑
Date of Pumping: Quantity Quantity Pumped: Q®� gallons
System Pumped by (Company): Permit 9:
Contents transferred to:
Contents disposed at:
LP
(/—)
Date Pumper Signature
Condition of system/other comments:
V.
CITY OF SALEM
®
HEALTH DEPT.
DEP APPROVED FORM- 1:/07/95
f FORM 4 - SYSTEM PUMPING RECORD
Commonwealth of Massachusetts
Massachusetts
System Pumping Record
System Owner ystem ocation
Type: Emergency ❑ Routine ZY �
Cesspool: No ❑ Ye L5 Septic Tank: No ❑ Yes ❑
Date of Pumping:l Quantity Pumped: gallons
System Pumped by (Company): � �"��'PI/1 Permit 4:
Contents transferred to:
.Contents disposed at: 510
Date Pumper Signature
Condition of system/other comments:
DEP APPROVED FO1LN1-12/07/95
r -
i FORM 4 - SYSTEM PUMPING RECORD
998 Commonwealth of Massachusetts
_
JUL 6 1 , Massachusetts
HE LATH DEPT System Pumping Record
System Owner System Location
Crr-�A v
Type: Emergency
- ,i�- Routine Et
Cesspool: No ❑ Yes Septic Tank: No F, Yes ❑
Date of Pumping:/ Quantity Pumped: gallons
System Pumped by (Company): �� Permit n:
Contents' transferred to:
.Contents disposed at: �
Date � 4(0 90 Pumper Signature
Condition of system/other comments:
DEP APPROVED FORM- 12/07/95 .
Yh/V�-Sr"FR CO/Y /� n sn�
P oOTFR-MAN FORD d s Si'S` i&l PL7O4PNG RECORD
r PFA"4ro yBOX71
A o1glo
Cominofi* alth of Mass9chtig@(tS
Massachusetts
E '
System Pumping Retord
ysten .,ocatonfFTrrZ-O6/3wPC.v
S63 c rn�
co � �
Quantity PuiHpedigallons
Ces-nlwol NO ❑ Yes Septic Tank: No
t yet ❑
astern Pumped b}•: em7 ��m4.` .?.._ ....... I
LrcenC #:
l 'nnt<.n ...ts lrancf?rred to: _ -S'e� lQ,.�
Date Inspector
SAVE
DEC t 1997
CITY OF s AL.EM
H'EALTI DEPT-
f