System pumping record 7-31-14 i
�9r85l2Et14 14:14 9782814869 i4INDRIVER PAGE 03/63
05!0312000
Commonweohth of Massachusetts Form 4--System pumping Retard' r'
Massachusetts
System Pumping Record
System Owner System Location
Weruwood Country Club Xernumod Country Club
1 Xernwood St 1 Sernwood St
Salem, M, 01970 Salem, MA, 01970
(978)-?45-1210 x (978)-745-7289 x
John Eggleston
Type: Emerg Routine
Cesspool: No Yea Serie ' No YeS�
Date of Pumping: j . (u Quantity Pumped:.,P-0eQ 6ellore
System Pumped By: Wind River Environmental,LLC Permit#:.
Contents Transferred to:
Contents Disposed at:
Oote: r Pumper Signature:
Condition of System/Other Comments
rag
tiS! vmuwonaard� Dep Approved Form 12/07/95