System pumping record 6-19-12 08102/2012 11: ^27 9782614869 WINDRIVER PAGE 04/05
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Commonwealth of Massachusetts Form 4--System Pumping RecordL26064
Massachusetts
System Pumping Record
System Owner System Location
Kernaood Country Club Xern«ood Country Club
1 xVrnwOpcI St 1 Kernwaod St
Salem, MA, 01970 Salem, MA, 01970 ,
(9778)-745-1210 x (976)-745-7289 x
John Eggleston �.
Type: Emergen Routine we �+
:esspool: No Yes Septic Tank: No YCSFYI
Date of Pumping: rte— R._ a Quantity Pumped: Gallons
System Pumped By: Wind River Environmental,LLC Permit#;
Contents Transferred to:
4
Contents Disposed at:
S.E.&D.
Salem, MA.
Date: Pumper Signature:
Condition of System/Other Comments
® meUnnrc a 1pnper Dep Approved Farm-12/07/95