System pumping record 12-31-13 03/05/2014 10: 16 9782814869 WINDRIVER PAGE 01/015
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Commonwealth of Massachusetts Form 4--System Pumping RecordSO%
Massachusetts
System Pumping Record
System Owner System Location
Aernwood Counkry Club Iternwood Country Club
1 il:ernvrooti 5t 1 Kernwood St
Salem, MAY O1S70 Salon, MA, 01970
(978)-•795-1210 x (978)-795-7289 x
John Eggleston
Type: Emergene Routine
Cesspool: No �, Yes Tank, „No� Ye
Date of Pumping: }Q13)1 cs Quantity Pumped: Gallons
TY—
System Pumped By: Wind River Environmental,LLC Permit 4',
Contents Transferred to:
contents Disposed et:
S 8 s-fl.
Date: 13 Pumper Sig
Condition of 5ystem/Other Comments "1 _
pNVINOrvmE Nin,/ -
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Drain Problems? We're Local&Fast
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® Frmr�o�ar=i�wxE Dep Approved Form-12/07/95