101 MARLBOROUGH RD lo
Commonwealth of Massachusetts
Salem, Massachusetts
System Pumping Record
System Owner& Address:
Residence
101 Marlborough Road
Salem, MA 01970
Location of system: Rear Ver)
Date of Pumping: December 19, 2011 DEC 2 8 2011
C11 -vF
BOARD SALEM
Type of system: Septic Tank OF HEALTH
Gallons Pumped: 1000 gallons
System pumped by:
Service Pumping& Drain Co., Inc.
5 Hallberg Park
North Reading, MA 01864
License#: BHP-2010-0358
License#: BHP-2010-0357
Contents
e is to: Fitchburg Treatment Plant
"Date `Dbcember 19, 2011 Pumping Technician: AS
This is PROPRIETARY and CONFIDENTIAL information that may
be used only by the Board of Health for regulatory purposes
Richard Brennan DBA 976-744-9103 P.1
�". 5 Hallberg Park
SERVICE North Reading, MA 01864 WORK ORDER
Pumping & Drain TOLL FREE: 800.794.9265
CO.,INC. FAX:978-276.05 DATE: �I
WEB:www.servicepumpining.com ARRIVE:
"Protecting Your Environment for Over 80 Years" DEPART:
HOME PH:
PML. WORK/CELL PH:
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❑NEW r] REPEAT p /
BILL TO: JOB NAME:
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PROBLEM: LOCATION:`_' ELEFT SIDE JOBTYPE: MERGENCY
❑INSIDE ❑OUTSIDE I-IFRONT 1y/REAR CIRIGHTSIDE ❑IN/NEXTTOORIVEWAY MAINTENANCE
/� ❑❑❑ US CONTRACT
` OTY WORK REQUESTED PRICE AMOUNT
t L]GREASE TRAP IN/OUT gallons/lbs.
SEPTICTANK gallons
` ❑CESSPOOL ggpbng
❑PUMP CHAMBER IN/OUT gallons
El SEWER MANHOLE IN/OUT gallons :
❑HOLDING TANK IN/OUT gallons
USAND TRAP IN/OUT gallons
l STORM DRAIN IN/OUT gallons
LJ OTHER IN l OUT gallons
I
DIGGING FT. IN.
LJTREATMENT:
❑HIGH PRESSURE WATERJET
LJ VIDEO PIPELINE INSPECTION
❑TITLE V INSPECTION
I I _
P.O.#
TRUCKk TECHNICIAN HOURS RATE AMOUNT TOTAL MATERIALS
TOTAL LABOR
TOT
Payment Method(circlo one): CASH CHECK MC VISA AMEX BILL(TERMS: EASE PAY WITHIN 30 DAYS)
CREDIT CARD N: EXP. CODE ZIP
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SIGNATURE:
Thank You
(I mby aCNn Isdg
gaiiikcWty wmpiet on 0 t o ab0v0 JWrlbad rwrk.)
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