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Commonwealth of Massachusetts Form 4-System Pumping Record 120%
Massachusetts
System Pumping Record
system Owner System Location
Schwartz Laurence Primary Home
5 Hilton St 5 Allton St
Salam, NCP., 01970 Salem, MA, 01970
(978)-745-7628 x (978)-745-7628 x
Schwartz Laurence
Type: Emergenc Routine
Cesspool: No Yes Septic Tank: No Yes
Date of Pumping: 1 :1— Quantity Pumped: Q U Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to:
Contents Disposed at: x.�w7 p
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Date: I _ Pumper Signature:
Condition of System/Other Comments 7
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Drain Problems? We're Local&Fast
1.866.866-6214
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Commonwealth of Massachusetts Form 4--System Pumping Record
Massachusetts
System Pumping Record
System Owner System Location j
Gouvieagh Debra Primary Home
4 Hilton Street 4 Hilton Street
Salem, MA, 01970 Salem, MA, 01970
(978)-815-0914 x (978)-815-0914 x
Gouvieaah
Type: Emergent Routine
Cesspool: No Yes Septic Tank: No = Yes
Date of Pumping: _ �� �%l] quantity Pumped: /000 Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to:
Contents Disposed at:
r31F��
Date: Pumper Signature:
Condition of System/Other Comments
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08/06/2014 14:35 9782814369 .IdINDRIL'ER ♦`� PAGE 09/14
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Commonwealth of Massachusetts Form 4--System Pumping Record 256°!
Massachusetts
System Pumping Record
System Owner System Location
Cauvreau Debra Primacy Bowe
4 Felton 4 5ilton Street
Salem, KA, 01970 Salem, t+A, 01970
(973)-315-0914 x (978)--815=0914 x
auvreau Debra
Type: Emergen Routine
Cesspool: No •' Yes Septic Tank: No Yes ~
Date of Pumping: quantity Pumped: ICODO Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
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Contents Transferred to
Contents Disposed at:
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Date: Pumper Signature: q
Condition of System/Other Comments
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Dep Approved Form-12/07/95
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03/06/2014 14:35 9762314669 WINDRIVER PAGE14/14
06/0412010
Commonwealth.of Massachusetts Form a--byste6 Pumping Record/
Massachusetts
System Pumping Record
System Owner System Location
vaUVr?rau Debra PNimary Nome
4 aj,lton Street 4 Hilton Street
:al m, tqA, 019?0 Salem, MA, 01970
(978)-915-0914 x (978)-815-0914 x
Gauvreau Debra
Type: Emergent Routine
Cesspool: No Yes 5eptic Tank: No = Yes
Date of Pumping:_ elr/� /Cie -
Quantity Pumped: /0W Gallons
System Pumped 8y: Wind River Environmental,LLC Permit#:
Contents Transferred to:
Contents Disposed at:
SHIM MA.
sate: �r ��(r Ll Pumper Signature: =^�"
Andition of System/Other Comments
&.n don—ydcdw r Dep Approved Form-12/07/95