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Commonwealth of Massachusetts Form 4--System Pumping Record
Massachusetts
System Pumping Record
System Owner System Location
Rent - All Inc Rent — Ali In.7
475 Highland Ave, 475 Highland Ave
Salem, MA, 01970 Salem, MA, 01970
!9781-744-4600 x (978)-744-4600 s
Michael
Type: Emergent Routine
Cesspool: No Yes Septic Tank: No Yes _
Date of Pumping: ,' ZCy _ I v Quantity Pumped: 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 TC,2C.2e
I
® 61n,edonmcycicdpaper Dep Approved Form- 12/07/95
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Commonwealth of Massachusetts Form 4--System Pumping Record
Massachusetts
System Pumping Record
Sysiem Owner System Location
Rent - All Inc Rent. - All Inc
475 Highland Ave 475 Highland Ave
Salem, MA, 01970 Salem, MA, 01970
(978?-744-4600 x (978)-744-4600 x
Michael
Type: Emergent Routine
Cesspool: No. �y Yes Septic Tank: No Yes
Date of Pumping: —�'^�Gp Quantity Pumped: {2 Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to: ,
Contents Disposed at:
Date: Pumper Signature: ��.'c
Condition of System/Other Comments
RECE1R4 Y.v
APR - 4 2008
CITY OF SALEM
BOARD OF H€AI TH
Dep Approved Form-12/07/95
0222018274 i(VI 2000
Commonwealth of Massachusetts Form 4--System Pumping Record
Massachusetts
System Pumping Record
System Owner System Location
Rent - All Inc Rent - All Inc
475 Highland Ave 475 Highland Ave
Salem, MA, 01970 Salem, MA, 01970
(978)-744-4600 x (978)-744-4600 x
Michael
Type: Emergent Routine
Cesspool: No Yes Septic Tank: No Yes
Date of Pumping: I,6 Quantity Pumped: Gallons
System Pumped By: Wind River Environmental,LLL Permit#:
Contents Transferred to:
Contents Disposed at:
Date: Pumper Signature: !i',i K 6J,, /Sd n
Condition of System/Other Comments
Dep Approved Farm-12/07/95
Commonwealth of Massachusetts Form 4--System Pumping Record
Massachusetts
System Pumping Record
System Owner System Location
Rent, — All Inc Rent — All Inc
475 Highland Ave 475 Highland Ave
Salem, MA, 01910 Salem, MA, U191U
(975)-744-4600 x (97b)-744-4600 x
Michael
Type: Emergenc Routine �
Cesspool: No Yes Septic Tank: No Yesd
Date of Pumping: &P 6 I Quantity Pumped: �( S Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to:
7
Contents Disposed at:
Date: b7 Pumper Signature:
Condition of System/Other Comments
RECEIVEIY-
SEP 10 2007
CITY OF SALEM
BogFiD OF HEALTH
Dep Approved Form-12/07/95
Commonwealth of Massachusetts Form 4-- umpmg Record
Massachusetts
System Pumping Record
System Owner System Location
--- :'__ Rent — All Inc
475 Highland Ave 475 Highland Ave
- - ---
Salem, MA, 01970 Salem, MA, 01970
(975) -744-4600 x (975)-744-4600 x
Type: Emergent Routine —�
Cesspool: No Yes _ Septic Tank: No Yesl
Date of Pumping: IV ^ Quantity Pumped:Kea-,) Gallons
System Pumped By: Wind River Environmental,LLL Permit#:
Contents Transferred to: -
Contents Disposed at: S�
Date: Pumper Signature: — M/✓�� ..
Condition of System/Other Comments _ '
`e lr N`a
SEP 13 2006
CITY OF SALEM
BOARD OF HEALTH
Dep Approved Form-12/07/95
44 577 Main Street,Suite 110. Hudson. Massachusetts 017491 E-Mail:
^ENVIRONMENTAL Telephone 978.562.4500 Facsimile 978562.7255 wrenvironmental.com
f)Ue Pt Vlq
FFg 102005 re
February 8, 2005
CIN Or SALEM
BOARD OF HEALTH
Wind River Environmental
163 Western Ave.
Gloucester, MA 01930
Board of Health Administrator,
This package contains the dump slips for the Board of Health from the field office
located in Gloucester, MA. This is the work we have completed.
If you have any questions, please feel free to contact our Director of Field Operations,
Brad Robertson, at 978-282-7315.
Thank you,
Miss illian tL
Commomveolth of MassachusetssMassachusetts F"Mo
System Pennine Record FEB 10 2005
CITY OF SALEM
BOARD OF HEALTH
System Owner System location
i
Type: Emugency /. Routine
Cesspool: Mo Yes Septic tank: �4.[fGiLYes
Date of Pumping: r Quantity Pumped: 6olions
System Pumped By: Wind 2'ver Environmental, LLC Permit#:
Contents transferred to:
(
Contents Disposed at:
Susi
Date: Pumper Signature:
ture: I
Condition of System/OMmr Comments
Dep Approved Form - 12/07/95
Form 4 -- System Pumping Racal
Co ns omveeith of Massadwsetss
Massachusetts
System Pumoim Raced
e�
System 0~ System location
ktn•, - >i.�.LL L..c R<,rt - All lnc
Ave 4'7ti d .yhland Ave
Sa'r,rt, "iA, 0t.?70 S'11-M, MA, pi97o
(4 ,5) 714-4000
Type: Emengeney Routine
Cesspool: No Yes Septic tank: KID 0Yes ®/
Date of Pumping: '� l�G, , Quantity Pumped: /.SJCID Gallons
System Pumped By: Wind River Envinwunentn/, LLC Permit#:
Contents tmnsfe red tat
Contents Disposed at: ✓ Z
S36
Date: `J pCJ -� Pumper Signature:
Condition of System/Other Comawft -
11I��,SIDV1 VVV MAY 5 - 2004 V
CITY OF SALEM
BOARD OF HEALTH
Dep Apprmd Form - 12/07/95
Form 4 System Pumping Record
Commonwealth of Massadwsetss
Massachusetts
System Pumping Record
System Owner System Location
4 Tit-
:'iml Irvi
)I
Type: Emergency Routine
Cesspool: No yes Septic tank: w MY.s
Data of Pumping; /I 6 (� Quantity Pumped: ISZ)o Gallons
System Pumped By: Wind Ni Ebmwnsionfal, LLC permit#:
Contents transferred to:
Contents Disposed at: yes L)
Date: /a 116 X� Pumper Signature:
Condition of System/Other Comments
JAN 12 2004
CITY OF SALEM
BOARD OF HEALTH
Dep Approved Form - 12/07/95
!!17
GETY OF SALEM
HEALTH DEPT,
� 4—
y�
C�v� R
SEPTIC $ DRAIN SER'V'ICE
107 PORES S T2-T,NMULT ?Tori,MA 011949
OCb'NCrN�n^dl.�'T7 3F MA5SA C• PJSR'TTS--
'1
Sl'C L7_1 PLT.r,a'1_J ' R Co"
SYSTEM Ott7JcfL . _ SYSTEM LOCA7lQN:
A
live...{ }
DATE OF FlJ14PTNG: too rho O c� .�'� �Iy '_TY PJN?ED: j soc' GALLONS
CESSPOOL: No F71 YES !,��- SEn- IC TPyK_'" NO �t s
SY8T M P'lUW- ED BY: PURPLER SUI TC &DRA^i SERVICE"
CON'T'ENTS"PRANSFBKR:D TO: S
St3_u.�SL'a�6Tc•�� XH.n
i-i%fj600, j,a 3l}�Hd l•iCl'di
Td Wta9'f:r_6 3000 11
FORM 4 - SYSTEM P
Commonwealth of Massachusetts
Massachusetts
MAY 4 -- 1999
CITY OF SALEM
System Pumping Record HEALTH DEPT.
System Owner —'System Location
7
Type: Emergency Routine ❑
Cesspool: No ❑ Yes Septic Tank: No Yes ❑
Date of Pumping: p�6 /Q�u�aantity Pumped: gallons
System Pumped by (Company): �� //��/1� Permit 9:
Contents transferred to:
Contents disp ed at:
Date Pumper Si e
Condition of system/other Comments:
�` DEP APPROVED FORA-12/07/95
' FORM 4 - SYSTEM P
Commonwealth of Massachusetts \�
Massachusetts
JUl 2 0 199b
System Pumping Record
CITY HEALTH
s rweerer ystem Location
Type: mergency Routine ❑
Cesspool: No Yes > Septic Tank: No ❑ YesAl
Date of Pumping: � � j�a�
p' � Quantity Pumped: v� gallons
System Pumped by (Company): � � Permit 9:
Contents transferred to:
Contents disposed at:
Date per Fri atarr
Condition of system/other comments:
DEP APPROVED F0M1.12/07/95
4f_ 4..49-flk Giy P- P £/-�e-
ptl��� w1Al� n r` � � �,>< i � ��{}��� bi t�lllt>�ti�lt��l`lI�C(71ttf
PIA OOYj 11n �Glr a flit , r
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l � 1
I
'OCT 11 6 9947
CI i Y Ur c H1.F-M
it
�yst�m..lmb�ng Itecvrd ',� ,
oa
-5ysie-m��er` ys em� oce on --
i
Dale of Pumping: ., Owwtlty Pumpedl /00.0gollom
('es-spool: No ❑ Yes d Septic Tm& No s' Y!s
System Pumped by. Al ....., _ .
Contents ttansfetiEd to:
i, l+
Date
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