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FORM 4-SYSTEM PUMPING RECORD
CURRIER DII
SEPTIC & DRAIN SERVICE D
107 FOREST STREET;MIDDLETON,MA 01949 NOV 1 5 1999
(978)774-2772
CITY OF SALEM
HEALTH DEPT.
COMMONWEALTH OF MASSACHUSETTS
(ems I MASSACHUSETTS
SYSTFMPUMPING PX CORD
SYSTEM OWNER: r 1 I SYSTEM LOCATION:
Te r-
oc ul,e
DATE OF PUMPING: /6-,-90 -99 QUANTITY PUMPED: GALLONS
CESSPOOL: NO YES F7 Su"Tj! T'AMK- NO YES
SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE
CONTENTS TRANSFERRED TO: SS�
DATE: INSPECTOR: r�r'O% f"
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