39 RAVENNA AVE 3 9 2Avt,�.�� .�,.�•
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107 Forest St. slo4FORM 4- SYSTEM PUMPLNG RECORD
Middleton,MA 01949 ID
(508) 774-2772
Commonwealth of Massachusetts NOV 12 1991
Massachusetts CITY OFSALEM
HEALTH DEPT.
System Pumping Record
ys[em ��Tter ystem Location
/7Q v�✓�/J�i d V( v � K
sect
Date of Pumping: Quantity Pumped�t-galIons
Cesspool: No ❑ Yes e Septic Tank: No ❑ . Yes ❑
y �
Sv stem Pumped by: License #: ..
Contents transferred to:
a .
Date !Z Inspector S
0 THE PROFESSIONAL EXPERTS IN THE SEPTIC AND DRAIN INDUSTRY 0