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i Commonwealth of Massachusetts Form 4--System Pumping Record
,j
Massachusetts
System Pumping Record
System Owner System Location
Spencer Contracting Job Site
P.O. Box 875 5 Eleanor Road
Salem, MA, 01970 Salem, MA, 01970
(978)-741-8000 x (97E1)-791-8000 x
Spencer Contracting
Type: Emergenc Routine
Cesspool: No Yes Septic Tank: No Yes��
Date of Pumping: 0 Quantity Pumped: lO� Gallons
System Pumped By: Wind River Environmental,LLL Permit#:
Contents Transferred to:
Contents Disposed at:
t /3
Date: Pumper Signature:
Condition of System/Other Comments
RECEIVED
SEP 10 2007 �--
CITY OF SALEM
( BOARD OF HEALTH
Dep Approved Form-12/07/95
C-5C�5
FORM 4 - SYSTEM PL7y2LNG D Commonwealth of Massachusetts
Massachusetts
Svstem Pumping Record
�ysiEm caner y5telT. oration
p` Emergency �7 Routine
�e.s?ool =o ❑ yeS Septic Tar.'.{: No ❑ Yes
Da._ Cr e Qsanty Pumped; 1�v� gel rs
q� c
5; �!em Pumped by lComp�r•y): Permit
�.ontent, tr2rs`erred to. -
Con!;nis �i oosed et
Cr• 0! S; .teT �0�^.er COP eP,tS:
MOW v ED
MAR 15 2001
CITY OF SAL.EN
BOARD OF HEALTH
FORM 4 • SYSTEM PUMPING :7CO D
Commonwealth of Massachuset ����
Massachusetts I O
Svstem Pu min¢ .R� ecord NOV 10 2004
system Location eiT2r
BOARD OF HEALTH
I
Fter-clency Routine rte
�'c ❑I zs Sz_. c a�:;: No ❑ Yes ZL,
Quantih; Pumped: 00 ga;len_
c-.;er:s trzn�.zrrec tc.
Pr Si)47.en re _
..... ..,, �:- V rC�e.m�Vt:�le ..•J mm l.�t
FORM 4 - SYSTEM PUMPING RECORD
Commonwealth of Massachusetts
Massachusetts
System Pumping Record
System Ovmer System Location
5,1E
Type: Emergency Routine ❑
Cesspool No ❑ J�,Yes_ /❑ Septic Tank: No El Yes
Date of Pumping: _`J1 � J��� Quantity Pumped: � gallons
System Pumped by (Company')- ` Per-mit 9:
Contents transferred to:
l
Contents disposed at:
4
Date P per signature l
s Condition of system/other comments:
T-4 V9
QV
`.�� 5 'L4iPT—
uTy
DEP APPROVFD FOP-M. 12/07/95
9
RO FORM 4 - SYSTEM PLIIPING RECORD
PEA^OYER-MAN JVD 13OX 471
tv'A Otpsa
Commonwealth of Massachusetts MAR 3 1 1998
Massachusetts CITY OFSALEIA
HEALTH DEPT,
System Pumping Record
ystem Owner Svstem Location
Date of Pumping: Quantity Pumped:A�.Qgallons
Cesspool: No ❑ Yes ❑ / Septic Tank: No ❑ Yes L�
System Pumped by: _ 11//VlC_" ............... .._ License n: _. _ _
. ... ...
Contents transferred to: 6 L
Date Inspector 4"� L
t
RbOtpq-XX�tA� >:ot 4 _ SYSt UI INIG lttt RD
- hEAfioore MA o ttAl�
commonwealth of Massachusetts i.iAY t° 0 1997
Masi;�ohUSettS d YOFGALEM'
i-, AL`s H DEPT.
Nys(ett Pa at3_tli k Record
System owner ^ ystemt Location
Dale of Pumping: ��i'O�Q Quantity Pumped:Q gal s
Cesspool No 0"� Yes ❑ Sep►ic Yank : No ❑ Yes
System Pumped byt . ................_ .. .:...... ..... ..(('��. ................ license if: ............................._ .
Contents lransferted to: S E J
Date inspector 0
V
A
s
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