400 HIGHLAND AVE t+0an
0222028482 10120!2006
Commonwealth of Massachusetts Form 4--System Pumping Record
Massachusetts
System Pumping Record
System Owner System Location
Mandarin Restaurant Mandarin P.estaurant
400 Highland Avenue 400 Highland Avenue
Salem, MA, 01970 Salem, MA, 0197U
(978)-740-0306 x (978)-'740-0306 x
Nancy or Ren
Type: Emergenc Routine
Cesspool: No Yes /IYbuTank: No Yes=
Date of Pumping: Quantity Pumped: /tom(-, Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to:
Contents Disposed at:
S.E.S.D.
Date: Pumper Signature
Condition of System/Other Comments
I
® printed onmycledpaper Dep Approved Form-12/07/95
DEC -3 2009
t, of SALEM
BOARD OF HEALTH
Commonwealth of Massachusetts Form 4--System Pumping Record
Massachusetts
System Pumping Record
System Owner System Location
Mandarin Restaurant Mandarin Restaurant
400 Highland Avenue 400 Highland Avenue
Salem, MA, 01970 Salem, MA, 01970
19761—'740-0306 x (978)-740-0306 x
Nancy or Ben
Type: Emergent Routine
Cesspool: No Yes bap#k Tank: No Yes
Date of Pumping: -�-a3 V Quantity Pumped:_Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to:
Contents Disposed at:
rl�
A E-S'D
Sierra, IIIA.
Date: Pumper Signaturee2 !/✓
Condition of System/Other Comments
® Printed onre yciedpaperr Dep Approved Form-12/07/95
0222026203 1012012008
c Commonwealth of Massachusetts Form 4--System Pumping Record
G Massachusetts
F'
System Pumping Record
System Owner V "' System Location
Mandarin Restauran f' Mandarin Restaurant
400 Highland Avenue AUG 5 2009 400 Highland Avenue
Salem, MA, 01970 ')F HLUM Salem, ?MA, 01970
(978)-740-0306 x 60µP (978)-740-0306 x
Nancy or Ban
Type: Emergenc Routine
Cesspool: No I�YCGSC
p �/ Yes Septic Tank: No Yes
Date of Pumping: -7- 'a,O -09 Quantity Pumped: ) QO() Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to:
Contents Disposed at:
S.E.S.D.
Salem, MA.
Date: Pumper Signature:
Condition of System/Other Comments
Dep Approved Form- 12/07/95