System pumping record 6-7-13 07118/2013 11:42 9782814869 WINDRIVER PAGE 0^4/P1^e
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Commonwealth of Massachusetts Farm 4--System Pumping Recard
Massachusetts
5ystem Pumping Record
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System 3 wner 5„�,-yztlpr�.,p}py +1. wz COULD USS A C
Xernwood Country Club Maintenence Building
1 Y( ,rnwocd St 1 Kernwood St
Salem, MA, 01.970 Saiem, MA, 01970
(978)-745-121.0 x (978)-745-1210 x
Kernwood Country Club
Type: Emergent Routine �.,
Cesspool: No � Yes Septic Tank; No Yes
Date of Pumping, Quantity Pumped: Gallons
System Pumped By: Wind River Environmental,LLC Permit#: `
Contents Transferred to:
Contents Disposed at:
S.E.&D.
pate: ' P m er 51 nature'
Condition of System/Other Comments
® rrnudorckdMw pep Approved Form-12/07/95 r
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