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PP\N log serest St. FORM 4- SYSTEM PUMPING RECORD
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''Gtk letun.MA 01949
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_Commonwealth of Massachusetts
Massachusetts
System Pumping Record
ystem UiAmer System Location
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�'0 7 C 0�`ayt�7l"P S� /I e �r �/V9//
Date of Pumping: �h I % Quantity Pumped: 45�c?0gallons
Cesspool: No ❑ Yes ❑ Septic Tank: No ❑ Yes ❑
System Pumped by: _.... _ ... _ . ............ .. ...- ... License #: .
Contents transferred to:
Date Inspector