System Pumping Records RECEIVED 05/18/2016 08:16AM 9787450343 Salem Health Dept
05/18/2016 08:14 9782814869 WINDRIVER PAGE 01/05
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System Pumping Record
MAY 16 2016
�UAFU OF H'���ti1
System owner System Location
Stinale Susan Primcry Romp-
,
ome1 %pietro avenuF 1 Dipietro avenue
5a1'na1, 'Nkr 07970 Salem, Nul, 01970
(617)-721.-0395 x (617)-721-0395 x
S t ira 1.a
T E er
Type: m gent ;11,outine /
Cesspool: No --EZ 1---if/y/
Dote of Pumping: � --� � �-'-p Septic Tank: Na Yes
Quantity Pumped:_ballons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to:
Contents Disposed at:
Date: Pumper 5ignature:
fondition of System/Other Comments
Salem.NiA.
trinaaoniecr��ooar Dep Approved Form-12/07/95
FORM 4 - SYSTEM Pr
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Commonwealth of Massachusetts U
Massachusetts OCT 1 —2003
System Pumping Record CITY ul= SALEM
F—SysARD OF HEALTH
tem weer System Location
Type. Emergency [Z . Routine (�
Cesspool: No ❑ Yes ❑ Septic Tank: No ❑ Yes
Date of Pumping: jr� Quantity Pumped: gallons
System Pumped by (Company): �1�—� (�l Permit k:
Contents transferred to:
Contents disposed at:
Date Pumper signature v
Condition of system/other comments:
r)EP APPROVED FOP01• 12107195
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FORM 4 - SYSTEM PUKING RECORD
Commonwealth of Massachusetts
G�1 Salem, Massachusetts
JUIN11 ,
CITY
HEALTH DEP T
System Pumvincr Record
System Owner: System Location:
Salvatore Spinale side yard
1 DiPietro Ave.
Salem
Date of Pumping: May 9, 2001 Quantity Pumped: 1000 gallons
Cesspool: No /X/Yes / / Septic Tank: No / / Yes /X/
System Pumped by: Service Pumping & Drain Co. Inc. License # 5-01
Contents transferred to: Salem Treatment Plant
Date: MaV 9 2001 Pumper: B.L.
This is PROPRIETARY and CONFIDENTIAL information that may be used
only by the Board of Health for regulatory purposes.
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