11 CEDARCREST ROAD SYSTEM PUMPING RECORDS RECEIVED 09/21/2016 12:22PM 9787450343 Salem Health Dept
09/21/2016 12:16 9782814869 WINDRIVER PAGE 01/02
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Commonwealth of Massachusetts Form 4—System Pumping Record 0°d
Massachusetts
5ystem Pumping Record
System Owner System Location
Jordan Glen Pr:-Kv�ry
11 Cedar Crest Road 11 Cedar
salem, Ma, 01970 Saler?, 21k, :i7_?%0
iv78)-65£-"Baas (978)-?.1'�•:°E�4 ;:
Jordan le n
Type: Emergent Routine
Cesspool: No yes Septic Tank: No Yes
bate of Pumping: �9 L.� �( Quantity Pumped:,4as;R�ca- Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to:
Contents bisposed at:
IGI/1
Date: Pumper Signature:
Condition of System/Other Comments
® Ptin4don mryckdyRr Dep Approved Form-12/07/95
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02/04/2015 07:37 9782814869 WINDRIVER PAGE 03/06
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Commonwealth of Massachusetts Form 4--System Pumping Recard
Massachusetts
5y5tem Pumping Record
System Owner System Location
Jordan Glen Primary Homo
:il Cedar Crest Road 11 Cedar Crest Road
Salem, MA, 019,70 Salem, ASA, 01970
(978)-552-9884' x (978)-745-3624 x
Jordan Glen
Type: Emergenc Routine
Cesspool: No yes Septic Tank: No yes '
Date of Pumping: 0_
Quantity Pumped: (Z,Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to:
Contents Disposed at:
Date: Pumper Signature: �
P .
Condition of System/Other Comments
Sale, SD
® rdmeaonmcyekGpuper Dep Approved Form-12/07/95
_.-.. _... ......... ..... .-_.
Commonwealth of MossachusettS Form 4 -- System Pumping Record
Massachusetts
System Pumping Record
System Owner . System Location y
r l{:YC4 °,i:,c-uf1 z m i n a ' Ft!.:kAea
i
j 1 !.nm, '6F, 01.970 R.3ivr„ :M}.,, i r't7'I
Type: Emergent Routine [f "
Cesspool: No Yes
Sepik Tank: Na Ye3�--'—"
Date of Pumpin¢ jJ-,+.-7 ��/ Quantity Pumped: Gallons
f
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to:
Contents Disposed at:
s.Es.D.
SWem, MA.
Date: - Pumper Signature: ✓f��G,7 ��
Condition of System/Other Comments
® h+r�.Kio�r�.,•-ieno@l* Dep Approved Form-:12/07/95
Form 4 -- System pumping Record
Commonwealth of Mossachusetss
Massachusetts
System Pumvina Record
System Owner System Location
1 'ad.tc GE.^:t. ';e;�,c! bl Cedar Crtvsr l;;;Sn
5,.tlom, t`A, I729'IG ;Mem, NU,, 61970
w9r 'riS..?E +1 >; �R7Er -75-3F�: x
Type: Emergency Routine
Cesspool: Ino / �• / Yes Septic tune: Ino YesPs Data of pumping: /V 'Z O �j `/ QuaMMy Pumped: _�
System Pumped By: wind A;Vw awwaosental, LLC Permit JF:
Contents transferred to:
Contents Disposed at:
Date: Pumper Signature:
Condition of System/Other Comments
Dep Approved Form - 12/07/95