System pumping record 9-30-13 12/09/2013 11:21 9782814869 WINDRIVER PAGE 06/11
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Commonwealth of Massachusetts Form a--System Pumping Record
Massachusetts
System Pumping Record
System Owner System Location
nerncrood Country Club Kernwood Country Club
1 Kernwaod St 1 Kernwood St
Salem, MA, 01970 Salem, MA, 01.970
(978)-7415-1210 x (978)-745-7289 x
.john Eggleston
Type: Emergency' Routine
Cesspool: No Yes _,moi Tank: No YesK
boteofPumping: q, `I-� Quantitypumped: Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to: �
Contents Disposed at: S���e�aE,,�.S.D. .
`i dM MA.
Date: Pumper Sig�naatuure:
Condition of System/Other Comments TA
Y/7
'V_
r�dta
® pnnUonmeydedpapa bep Approved Farm-12/07/95