14 CEDARCREST ROAD SYSTEM PUMPING RECORD 6-24-08 /lhhhlhh�lM nn�nwenwwn
Commonwealth of Massachusetts Form 4--System Pumping Record
Massachusetts
System Pumping Record
System Owner System Location
Marquis Doreen Primary Home
14 Cedar Crest Rd 14 Cedar Crest Rd
Salem, MA, 01970 Salem, MA, 01970
(978) -74,-1599 x (978) -744-1599 x
Marquis
Type: Emergent Routine
Cesspool: . No Yes Septic Tank: No Yes=
Date of Pumping: b�bol Quantity Pumped OQ Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to:
/ Sal oFKU
Contents Disposed at:
Date: Pumper Signature:
Condition of System/Other Comments
FRECEIVED
IJUL 8-2000
CITY OF SALEM
BOARD OF HEALTH
Dep Approved Form- 12/07/95