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Commonwealth of Massachusetts Form 4--System Pumping Record
Massachusetts
System Pumping Record
System Owner System Location
Gvftiio Orlando Primary Home
15 Orleans Avenue 15 Orleans Avenue
Salem, MA, 01970 Salem, MA, 01970
(978)-744-5662 x (978)-744-5662 x
Gallo Orlando
Type: Emergent Routine
Cesspool: No Yes Septic Ton<: No Yes��
Date of Pumping: /„ �� Quantity Pumped: t 0a d Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to:
Contents Disposed at:
Date: Pumper Signature:
Condition of System/Other Comments
RECEIVED
IJUL 9 -2008
CITY OF SALEM
RnARD OF HEALTH
Dep Approved Form-12/07/95
{/ 577 Main Street,Suite 110, Hudson, Massachusetts 01749 E-Mail:
E N V I R )N M EVN TA L Telephone 978.562.4500 Facsimile 973.562.7255 wrenvironmental.com
November 15, 2005
Wind River Environmental f laa
163 Western Ave.
Gloucester, MA 01930 CITY �
E30ARd OF HEALTH
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.
n Branch Manager, David Martin
If you have any questions, please feel free to contact our g ,
at 978-282-7315.
Thank you,
Miss Jillia . LaFlam
Form 4 -- System Pumping Record
Commonwealth of Massachusetss
Massaclsnsetts
y System Pumoino Record
System Owner System Location
Gallo Orlando Primary Home
15 Orleans Ave 15 Orleans Ave
Salem, MA, 01970 Salem, MA, 01970
(978) -744 -5662 x (978)-744-5562 x
Type: Emergency Routine
Cesspool: w Yes Septic tank: w Elves
Date of Pumping: AA Quantity Pumped: Z(nL7C7>Ga)1ons
61
System Pumped By: Wind Rite Ennromnenta/, LLC permit M:
Contents transferred to:
Contents Disposed at:
Date: pumper Sigrgty
Condition of SystwWOther Comments
V IA
O
1MV I NO
CITY OF 3" /1LEM
BOARD OF HEALTH
--- Dep Approved Form - 12/07/95 --