System pumping record 3-27-13 05/08/2013 13:32 9782B14869 WINDRIVER PAGE 06/07
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Commonwealth of Massachusetts Farm 4--System Pumping Record 2507,
Massachusetts
System Pumping Record
System Owner System Location
Kernwood Country club Karnwood. Country Club
I ]{p,CtiNgoci St
l 1te.rnwood St
Salem, MA, 01970 saicm, !AA, 01970
(9716)-745-1210 x (778)-745--7289 x
lohn Eggleston
Type: Emergemc Routine ✓ Gee
Cesspool: No ✓ Yes Septic Tank: No Yes
Date of Pumping: _ lq7— hj Quantity Pumped:5C. -kilons
system Pumped By! Wind River Environmental,LLC. Permit#:
Contents Transferred to:
Contents Disposed at:
Date: Pumper Signature:
Condition of System/Other Comments
0 .Nm dwxgcl�p� Dep Approved Form-12/07/95